Takeda Haruhiko, Nishikawa Hiroki, Iguchi Eriko, Matsuda Fumihiro, Kita Ryuichi, Kimura Toru, Osaki Yukio
Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 Japan.
Clin J Gastroenterol. 2012;5(4):407-12. doi: 10.1007/s12328-012-0339-9. Epub 2012 Oct 22.
Little is known about acute interstitial pneumonia (AIP) induced by sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC). Here, we present three patients with advanced HCC who developed AIP during sorafenib therapy, with fatal complications in two cases. Case 1 was a 76-year-old man who developed dyspnea. Chest CT showed interstitial pneumonia. Sorafenib was discontinued immediately, and prednisolone was started. His pneumonia resolved. A drug-induced lymphocyte stimulation test for sorafenib was positive. Case 2 was a 75-year-old man and case 3 was a 77-year-old man, both of whom developed high-grade fever and hypoxemia during sorafenib therapy, and were diagnosed with AIP. In spite of high-dose steroid therapy, their respiratory failure worsened and both patients died. In all three cases, serum KL-6 or surfactant protein D concentrations were elevated, and blood and sputum cultures did not grow pathogens. All three patients were smokers with restrictive lung disease on preoperative respiratory function testing, but did not have respiratory symptoms before sorafenib therapy. The clinical features of these three cases suggest that male gender, older age, smoking history, and lung disease are associated with acute sorafenib-induced AIP in patients with advanced HCC.
关于索拉非尼治疗晚期肝细胞癌（HCC）患者所诱发的急性间质性肺炎（AIP），目前所知甚少。在此，我们报告3例晚期HCC患者，他们在索拉非尼治疗期间发生了AIP，其中2例出现致命并发症。病例1为一名76岁男性，出现呼吸困难。胸部CT显示间质性肺炎。立即停用索拉非尼，并开始使用泼尼松龙治疗。其肺炎得以缓解。索拉非尼的药物诱导淋巴细胞刺激试验呈阳性。病例2为一名75岁男性，病例3为一名77岁男性，两人在索拉非尼治疗期间均出现高热和低氧血症，并被诊断为AIP。尽管给予了大剂量类固醇治疗，他们的呼吸衰竭仍恶化，两名患者均死亡。在所有3例病例中，血清KL-6或表面活性蛋白D浓度均升高，血液和痰培养均未培养出病原体。所有3例患者均为吸烟者，术前呼吸功能测试显示有限制性肺病，但在索拉非尼治疗前均无呼吸道症状。这3例病例的临床特征表明，男性、老年、吸烟史和肺部疾病与晚期HCC患者急性索拉非尼诱导的AIP有关。
