Ash-Bernal Rachel, Browner Ilene, Erlich Rodrigo
Department of Internal Medicine, Division of Hematology and Oncology, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224-2780, USA.
Cancer Invest. 2002;20(7-8):876-9. doi: 10.1081/cnv-120005899.
A 69-year-old patient with non-small cell lung cancer developed pneumonitis with the use of the chemotherapeutic drugs gemcitabine, paclitaxel, and vinorelbine. He developed progressively worsening dyspnea, fevers, chills, and night sweats three weeks after initiation of chemotherapy treatment with no improvement with antibiotics. Bronchoscopic lung biopsy and endotracheal cultures were negative. Four weeks after the onset of symptoms, chest computed tomography scan showed a ground glass appearance of the lung parenchyma bilaterally consistent with pneumonitis. Gemcitabine is a nucleoside analog with activity against solid tumors, including breast and non-small cell lung cancers. Pneumonitis is a rare and potentially deadly complication of gemcitabine. Early treatment with corticosteroids leads to a complete resolution of this patients pneumonitis. Gemcitabine was discontinued and his chemotherapeutic regimen was changed to include paclitaxel, vinorelbine, and topotecan with no recurrence of pneumonitis. Pneumonitis should be included in the differential diagnosis of dyspnea in patients undergoing gemcitabine-based chemotherapy.
一名69岁的非小细胞肺癌患者在使用化疗药物吉西他滨、紫杉醇和长春瑞滨后发生了肺炎。在开始化疗治疗三周后，他出现了进行性加重的呼吸困难、发热、寒战和盗汗，使用抗生素后无改善。支气管镜肺活检和气管内培养均为阴性。症状出现四周后，胸部计算机断层扫描显示双侧肺实质呈磨玻璃样外观，符合肺炎表现。吉西他滨是一种核苷类似物，对包括乳腺癌和非小细胞肺癌在内的实体瘤有活性。肺炎是吉西他滨罕见且可能致命的并发症。早期使用皮质类固醇治疗可使该患者的肺炎完全消退。停用吉西他滨，其化疗方案改为包括紫杉醇、长春瑞滨和拓扑替康，未再发生肺炎。在接受以吉西他滨为基础的化疗的患者中，肺炎应列入呼吸困难的鉴别诊断。
