Tamura Jun, Nakauchi Masaya, Nakayama Yusuke, Kitaguchi Kazuhiko, Sakikubo Morito, Ura Katsuaki, Taira Kaoru, Ohe Hideaki, Yoshikawa Akira, Ishigami Shun-Ichi, Baba Nobuo
Dept. of Gastroenterology, Otsu Red Cross Hospital.
Gan To Kagaku Ryoho. 2009 Dec;36(13):2665-8.
A 64 -year-old female received oral S-1 chemotherapy followed by mFOLFOX6 chemotherapy for postoperative liver and lung metastasis of sigmoid colon cancer. The tumor progression was observed after twelve courses of mFOLFOX6 chemotherapy, and then FOLFIRI+bevacizumab chemotherapy was performed. After two courses of FOLFIRI+bevacizumab chemotherapy, leucopenia was observed. The chemotherapy was then discontinued and G-CSF was administered. Two days later she complained of high fever and dry cough, and was admitted to the hospital. A diffuse ground-glass appearance of bilateral lung was observed on chest X-ray and CT. Drug-induced interstitial pneumonitis was suspected, and Pneumocystis carini pneumonia was considered in the differential diagnosis. Oral administration of prednisolone and sulfamethoxazole/trimethoprim did not improve the symptoms, so steroid pulse therapy was performed. Steroid pulse therapy improved respiratory symptoms, but CT findings did not change remarkably. After nine weeks in the hospital, she was discharged with home oxygen therapy. Interstitial pneumonitis induced by FOLFIRI+bevacizumab chemotherapy is rare, but the number of cases may increase with increased use of this regimen. The possibility of interstitial pneumonitis should always be considered when the patient presents with a respiratory disorder while receiving systemic chemotherapy.
一名64岁女性因乙状结肠癌术后肝肺转移接受口服S-1化疗，随后接受mFOLFOX6化疗。在进行12个疗程的mFOLFOX6化疗后观察到肿瘤进展，随后进行FOLFIRI+贝伐单抗化疗。在进行两个疗程的FOLFIRI+贝伐单抗化疗后，观察到白细胞减少。随后停止化疗并给予粒细胞集落刺激因子（G-CSF）。两天后，她出现高热和干咳，并入院治疗。胸部X线和CT检查发现双肺呈弥漫性磨玻璃样改变。怀疑为药物性间质性肺炎，鉴别诊断时考虑卡氏肺孢子虫肺炎。口服泼尼松龙和磺胺甲恶唑/甲氧苄啶未能改善症状，因此进行了激素冲击治疗。激素冲击治疗改善了呼吸症状，但CT表现无明显变化。住院9周后，她出院并接受家庭氧疗。FOLFIRI+贝伐单抗化疗引起的间质性肺炎较为罕见，但随着该方案使用的增加，病例数可能会增加。当患者在接受全身化疗时出现呼吸系统疾病时，应始终考虑间质性肺炎的可能性。
