Carrión Valero F, Bertomeu González V
Servicio de Neumología. Hospital Clínico Universitario. Facultad de Medicina. Universitat de València. Valencia. Spain.
Arch Bronconeumol. 2002 Oct;38(10):492-4. doi: 10.1016/s0300-2896(02)75272-1.
Although the side effects of thalidomide are well known, lung toxicity has not been reported. We describe the case of a 65-year-old man with multiple myeloma (IgG kappa) in stage IA who, on the thirty-seventh day of treatment with thalidomide, developed acute coughing, general malaise, dyspnea at rest and sudoresis. Blood pressure was 90/60 mm Hg and temperature was normal. An interstitial and alveolar pattern was visible on the right side of a chest film and arterial blood gases indicated partial respiratory insufficiency (pH 7.40, PaCO2 40 mmHg, PaO2 47 mmHg). Blood analysis showed alterations expected for multiple myeloma and microbiology was negative (sputum and blood cultures and urinary antigen detection for Streptococcus pneumoniae and Legionella pneumophila). After thalidomide was withdrawn and oxygen and intravenous corticoids were administered, outcome was good. A chest film 4 days later was normal and arterial blood gases showed that respiratory insufficiency had disappeared. We conclude that severe lung toxicity should be included among the potential adverse effects of thalidomide.
尽管沙利度胺的副作用众所周知，但肺部毒性尚未见报道。我们描述了一例65岁IA期多发性骨髓瘤（IgG κ型）男性患者，在使用沙利度胺治疗的第37天，出现急性咳嗽、全身不适、静息时呼吸困难和多汗。血压为90/60 mmHg，体温正常。胸部X线片显示右侧有间质和肺泡样改变，动脉血气分析提示存在部分呼吸功能不全（pH 7.40，PaCO2 40 mmHg，PaO2 47 mmHg）。血液分析显示出多发性骨髓瘤预期的改变，微生物学检查为阴性（痰、血培养及肺炎链球菌和嗜肺军团菌尿抗原检测）。停用沙利度胺并给予吸氧和静脉注射皮质类固醇后，预后良好。4天后胸部X线片正常，动脉血气分析显示呼吸功能不全已消失。我们得出结论，严重肺部毒性应被纳入沙利度胺潜在的不良反应之中。
