Dahlqvist C, Fremault A, Carrasco J, Colinet B
Service de pneumologie, Grand hôpital de Charleroi, rue de la Duchère, 6 6060 Gilly, Belgique.
Rev Mal Respir. 2010;27(1):84-7. doi: 10.1016/j.rmr.2009.06.001. Epub 2009 Dec 16.
FOLFOX 4 chemotherapy (5-fluorouracil, leucovorin and oxaliplatin) is the standard adjuvant treatment for stage III colon cancer. The principal secondary effects described are haematological, gastro-intestinal or neurological. A single case of obliterative bronchiolitis with organising pneumonia has been described recently.
We report the case of a female patient aged 74 years who, after 12 courses of FOLFOX 4 chemotherapy, developed acute onset of severe shortness of breath and a dry cough but remained afebrile. A thoracic CT-scan showed symmetrical bilateral interstitial infiltration that was reticular in appearance, and predominantly basal and peripheral in distribution. Broncho-alveolar lavage revealed an alveolitis with 9% eosinophils and 4% neutrophils. Transbronchial biopsies showed the appearances of obliterative bronchiolitis with organising pneumonia. Systemic corticosteroid treatment led to a remarkable clinical and functional improvement.
To our knowledge, this is the second case of obliterative bronchiolitis with organising pneumonia that has been described following adjuvant treatment based on FOLFOX 4.
FOLFOX 4化疗方案（5-氟尿嘧啶、亚叶酸钙和奥沙利铂）是III期结肠癌的标准辅助治疗方案。所描述的主要副作用为血液学、胃肠道或神经系统方面的。最近有一例闭塞性细支气管炎伴机化性肺炎的病例报道。
我们报告一例74岁女性患者，在接受12个疗程的FOLFOX 4化疗后，突然出现严重气短和干咳，但无发热。胸部CT扫描显示双侧对称性间质浸润，呈网状，主要分布在肺底部和周边。支气管肺泡灌洗显示肺泡炎，嗜酸性粒细胞占9%，中性粒细胞占4%。经支气管活检显示闭塞性细支气管炎伴机化性肺炎的表现。全身使用皮质类固醇治疗后，临床和功能有显著改善。
据我们所知，这是第二例在基于FOLFOX 4的辅助治疗后出现闭塞性细支气管炎伴机化性肺炎的病例。
