Dhakal Binod, Singh Veerpal, Shrestha Anuj, Rao Arjun, Choong Nicholas
Medical College of Wisconsin, Milwaukee, USA.
Clin Pract. 2011 Nov 8;1(4):e106. doi: 10.4081/cp.2011.e106. eCollection 2011 Sep 28.
Pemetrexed is an antifolate chemotherapy agent that is active in malignant mesothelioma and non-small cell lung cancer (NSCLC). Pneumonitis is a rare side effect of Pemetrexed. We report the case of 72-year-old female with metastatic poorly differentiated lung adenocarcinoma. She was placed on maintenance pemetrexed and developed gradual progressive dyspnea after first cycle of maintenance of pemextrexed. The computed tomography (CT) of the chest showed ground glass opacity in both lung fields. Transbronchial lung biopsy showed uniform interstitial widening by a cellular chronic infiltrate with areas of type II pneumocyte and exudation of pale eosinophilic edema fluid; features consistent with acute lung injury. Patient improved both clinically and radiological after stopping pemetrexed and starting prednisone. Although pemetrexed induced lung injury is relatively rare, with the increasing use of peme-trexed in first-line treatment and in maintenance therapy of non-small cell lung cancer, awareness of this potential adverse effects is important.
培美曲塞是一种抗叶酸化疗药物，对恶性间皮瘤和非小细胞肺癌（NSCLC）有效。肺炎是培美曲塞罕见的副作用。我们报告一例72岁女性转移性低分化肺腺癌患者。她接受培美曲塞维持治疗，在第一个周期的培美曲塞维持治疗后逐渐出现进行性呼吸困难。胸部计算机断层扫描（CT）显示双肺野磨玻璃影。经支气管肺活检显示细胞性慢性浸润导致间质均匀增宽，伴有II型肺泡上皮细胞区域及淡嗜酸性水肿液渗出；这些特征符合急性肺损伤。患者在停用培美曲塞并开始使用泼尼松后，临床症状和影像学表现均有所改善。尽管培美曲塞引起的肺损伤相对罕见，但随着培美曲塞在非小细胞肺癌一线治疗和维持治疗中的使用增加，认识到这种潜在不良反应很重要。
