Toma Andrew, Rapoport Aaron P, Burke Allen, Sachdeva Ashutosh
FAU College of Medicine Boca Raton FL USA.
Division of Hematology and Oncology University of Maryland School of Medicine Baltimore MD USA.
Respirol Case Rep. 2017 Apr 25;5(4):e00233. doi: 10.1002/rcr2.233. eCollection 2017 Jul.
Multiple myeloma is a plasma cell dyscrasia accounting for 10% of haematologic malignancies. Lenalidomide is an immunomodulatory drug analogous to thalidomide that is approved for use in patients with myelodysplastic syndrome, and in combination with dexamethasone for refractory or relapsed multiple myeloma. Lenalidomide is preferred to thalidomide because of reduced toxicity, and pulmonary side effects are considered rare. We present, to our knowledge, an unusual and first reported case of a patient with relapsed multiple myeloma who received lenalidomide after autologous stem cell transplant, then developed eosinophilic pneumonia presenting as dyspnoea, peripheral eosinophilia, and bilateral pulmonary opacities. Bronchoscopy with bronchoalveolar lavage was negative for infection, and transbronchial lung biopsies showed eosinophilic pneumonia. After discontinuation of lenalidomide and initiation of prednisone therapy, his dyspnoea improved and eosinophilia resolved; however, symptoms recurred when the drug was restarted at a lower dose, confirming its causative role. In the absence of infection, clinicians should always bear in mind drug toxicity in the differential diagnosis of patients receiving lenalidomide and related agents.
多发性骨髓瘤是一种浆细胞发育异常疾病，占血液系统恶性肿瘤的10%。来那度胺是一种与沙利度胺类似的免疫调节药物，已被批准用于治疗骨髓增生异常综合征患者，以及与地塞米松联合用于治疗难治性或复发性多发性骨髓瘤。由于毒性较低，来那度胺比沙利度胺更受青睐，且肺部副作用被认为较为罕见。据我们所知，我们报告了一例不寻常的复发性多发性骨髓瘤患者，该患者在自体干细胞移植后接受来那度胺治疗，随后出现嗜酸性粒细胞性肺炎，表现为呼吸困难、外周血嗜酸性粒细胞增多和双侧肺部混浊。支气管镜检查及支气管肺泡灌洗未发现感染，经支气管肺活检显示为嗜酸性粒细胞性肺炎。停用 来那度胺并开始使用泼尼松治疗后，患者的呼吸困难症状改善，嗜酸性粒细胞增多症消退；然而，当以较低剂量重新开始使用该药物时，症状复发，证实了其致病作用。在没有感染的情况下，临床医生在对接受来那度胺及相关药物治疗的患者进行鉴别诊断时，应始终牢记药物毒性。
