Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Thorac Cancer. 2020 Jul;11(7):2040-2043. doi: 10.1111/1759-7714.13473. Epub 2020 May 6.
A 49-year-old man presented to our outpatient clinic complaining of nonproductive cough and exertional dyspnea for two months. He had been diagnosed with large B cell non-Hodgkin's lymphoma seven months previously, and the tumor had almost disappeared after four cycles of rituximab-containing chemotherapy. He then developed a severe dry cough, progressive dyspnea and hypoxia two weeks after the fifth cycle. Bilateral diffuse ground-glass opacities were visible on chest X-ray. Although the patient's symptoms were ameliorated temporarily after two weeks of methylprednisolone administration and multiple antibiotics, exertional dyspnea had progressed slowly starting one month after discontinuation of the corticosteroid. A repeat chest computed tomography (CT) scan showed diffuse ground-glass opacities, bronchoalveolar lavage fluid tests for pathogens were negative and the pathological manifestation of the transbronchial lung biopsy showed nonspecific interstitial pneumonia. Rituximab-induced interstitial lung disease was diagnosed after multidisciplinary discussion. Prednisone was again prescribed and his symptoms and the pulmonary opacities gradually disappeared. Although various pulmonary infections are the most common respiratory complications in patients with non-Hodgkin's lymphoma undergoing rituximab-containing chemotherapy, noninfectious diffuse lung disease, eg, drug-associated interstitial lung disease might be considered as a differential diagnosis of patients treated with rituximab, especially if a patient is nearing the time of administration of a fourth cycle of rituximab.
一位 49 岁男性因干咳和活动后呼吸困难 2 个月就诊于我院门诊。他在 7 个月前被诊断为大 B 细胞非霍奇金淋巴瘤，在接受 4 个周期含利妥昔单抗的化疗后，肿瘤几乎消失。在第 5 个周期后 2 周，他出现严重干咳、进行性呼吸困难和缺氧。胸部 X 线显示双侧弥漫性磨玻璃影。尽管患者在接受甲基强的松龙治疗和多种抗生素治疗 2 周后症状暂时缓解，但在停用皮质类固醇后 1 个月，活动后呼吸困难逐渐加重。重复胸部 CT 扫描显示弥漫性磨玻璃影，病原体支气管肺泡灌洗液检测为阴性，经支气管肺活检的病理表现为非特异性间质性肺炎。经多学科讨论后诊断为利妥昔单抗诱导的间质性肺病。再次给予泼尼松龙治疗，他的症状和肺部浸润逐渐消失。尽管各种肺部感染是非霍奇金淋巴瘤患者接受含利妥昔单抗化疗后最常见的呼吸道并发症，但在接受利妥昔单抗治疗的患者中，非传染性弥漫性肺部疾病，如药物相关的间质性肺病，可能被认为是鉴别诊断之一，尤其是当患者接近第 4 个周期利妥昔单抗治疗时间时。
