Bartl Mery, Ng-Wong Yilen K, Alexander Blesset, Gomez Casanovas Jose G, Rodriguez-Paez Josenny L, Suarez Andres, Loftis Christine E
Internal Medicine, University of Texas Rio Grande Valley School of Medicine, McAllen, USA.
Internal Medicine, University of Texas Rio Grande Valley, McAllen, USA.
Cureus. 2023 Feb 21;15(2):e35263. doi: 10.7759/cureus.35263. eCollection 2023 Feb.
Cyclophosphamide (CYC) is an immunosuppressive medication used to treat life-threatening complications of various rheumatic diseases like vasculitis and systemic lupus erythematosus. A rare side effect of this medication is pneumonitis, which occurs in less than 1% of patients. We describe a case of an 83-year-old woman with a past medical history of microscopic polyangiitis, who presented with progressive dyspnea at rest, exacerbated on exertion, and associated with orthopnea that was attributed to CYC-induced pneumonitis. Three months before this presentation, the patient was diagnosed with antineutrophil cytoplasmic antibodies (ANCA)-positive pauci-immune crescentic and necrotizing glomerulonephritis and started on CYC. On admission, a computed tomography (CT) chest showed worsening bilateral ground-glass opacities in a mosaic distribution and inter and intralobular septal thickening, not present on the CT performed three months prior. The patient underwent an extensive workup, which included an echocardiogram, bronchoscopy with bronchoalveolar lavage, and viral respiratory panel to rule out infectious and cardiac pathologies. She was started on empiric treatment with antibiotics and diuretics, however, despite these interventions, she continued with respiratory distress. A multidisciplinary team convened, and the diagnosis of CYC-induced lung injury was entertained. The CYC was discontinued, and the patient was started on prednisone with significant improvement in symptoms. This case highlights the importance of recognizing CYC as a rare cause of interstitial pneumonitis. When considering CYC-induced lung toxicity, other etiologies, such as opportunistic infections, cardiac etiologies, and diffuse alveolar hemorrhage, should be ruled out.
环磷酰胺（CYC）是一种免疫抑制药物，用于治疗各种风湿性疾病（如血管炎和系统性红斑狼疮）危及生命的并发症。这种药物的一种罕见副作用是肺炎，发生率不到1%的患者。我们描述了一例83岁女性，既往有显微镜下多血管炎病史，出现进行性静息性呼吸困难，运动时加重，并伴有端坐呼吸，归因于CYC诱导的肺炎。在此次就诊前三个月，患者被诊断为抗中性粒细胞胞浆抗体（ANCA）阳性少免疫性新月体性坏死性肾小球肾炎，并开始使用CYC治疗。入院时，胸部计算机断层扫描（CT）显示双侧磨玻璃影呈马赛克样分布且小叶间隔增厚加重，三个月前的CT检查未见此表现。患者接受了全面检查，包括超声心动图、支气管镜检查及支气管肺泡灌洗，以及病毒呼吸道检测以排除感染性和心脏疾病。她开始接受抗生素和利尿剂的经验性治疗，然而，尽管采取了这些干预措施，她仍持续存在呼吸窘迫。一个多学科团队进行了会诊，并考虑了CYC诱导的肺损伤诊断。停用CYC，患者开始使用泼尼松治疗，症状有显著改善。该病例强调了认识到CYC是间质性肺炎罕见病因的重要性。在考虑CYC诱导的肺毒性时，应排除其他病因，如机会性感染、心脏病因和弥漫性肺泡出血。
