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阿扎胞苷诱发的隐源性机化性肺炎:一例病例报告及文献复习

Azacitidine-induced cryptogenic organizing pneumonia: a case report and review of the literature.

作者信息

Alnimer Yanal, Salah Samer, Abuqayas Bashar, Alrabi Kamal

机构信息

Internal Medicine Department, Hurley Medical Center, Flint, MI, USA.

Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan.

出版信息

J Med Case Rep. 2016 Jan 20;10:15. doi: 10.1186/s13256-016-0803-0.

Abstract

BACKGROUND

Myelodysplasia syndrome is a heterogeneous group of hematological disorders that are characterized by abnormal morphology and cytopenias of bone marrow elements. Azacitidine is a hypomethylating agent that is commonly used in treatment of myelodysplasia syndrome. We present an extremely rare case of cryptogenic organizing pneumonia following therapy with azacitidine and a review of the relevant literature. This is the fifth case of azacitidine-induced interstitial lung disease and the sixth one due to hypomethylating drugs; of interest, this is the first reported case that has occurred after the second cycle. Our case report highlights an important, potentially treatable and rare side effect of azacitidine and hypomethylating agents in general that might be overlooked by oncologists. Furthermore, our review of the literature showed heterogeneity in the clinical outcome which might, in part, be due to delay in initiating corticosteroids treatment.

CASE PRESENTATION

A 67-year-old white man presented with worsening shortness of breath and mild productive cough that started 1 week prior to his presentation. An initial chest X-ray showed infiltration of both lung fields. Radiographic findings of computed axial tomography, results of bronchoscopy and a lung biopsy were consistent with cryptogenic organizing pneumonia. The patient showed variable clinical response to steroids and he remained dependent on home oxygen.

CONCLUSIONS

We concluded that there is a recognizable potentially life-threatening toxicity due to organizing pneumonia secondary to azacitidine in the setting of myelodysplasia syndrome treatment. This toxicity is not limited to the first cycle as in previous cases; furthermore, pleural effusion can be associated with this toxicity. Health care professionals should be aware of this recognizable side effect. Early recognition and timely management are critical to prevent permanent lung fibrosis.

摘要

背景

骨髓增生异常综合征是一组异质性血液系统疾病,其特征为骨髓细胞形态异常和血细胞减少。阿扎胞苷是一种低甲基化药物,常用于治疗骨髓增生异常综合征。我们报告一例极为罕见的阿扎胞苷治疗后隐源性机化性肺炎病例,并对相关文献进行综述。这是阿扎胞苷诱发间质性肺病的第五例,也是低甲基化药物所致的第六例;有趣的是,这是首例在第二个疗程后发生的病例。我们的病例报告凸显了阿扎胞苷及一般低甲基化药物一种重要、可能可治疗但罕见的副作用,肿瘤学家可能会忽视。此外,我们的文献综述显示临床结果存在异质性,这可能部分归因于启动皮质类固醇治疗的延迟。

病例介绍

一名67岁白人男性,就诊前1周出现进行性加重的气短和轻度咳痰。初始胸部X线显示双肺野浸润。计算机断层扫描的影像学表现、支气管镜检查结果及肺活检结果均符合隐源性机化性肺炎。患者对类固醇的临床反应不一,仍需家庭氧疗。

结论

我们得出结论,在骨髓增生异常综合征治疗中,阿扎胞苷继发机化性肺炎可导致一种可识别的潜在危及生命的毒性。这种毒性并不像之前病例那样仅限于第一个疗程;此外,胸腔积液可能与这种毒性相关。医护人员应意识到这种可识别的副作用。早期识别和及时处理对于预防永久性肺纤维化至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/148a/4721185/0dadf5824527/13256_2016_803_Fig1_HTML.jpg

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