A rare presentation of panitumumab-involved interstitial lung disease: Spontaneous pneumomediastinum

2021 ◽  
pp. 107815522110179
Author(s):  
Nuri Yakar ◽  
Bisar Ergun ◽  
Levent Ugur ◽  
Umit Can Ates ◽  
Sinem Gezer ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Colorectal Carcinoma ◽  
Lung Disease ◽  
Subcutaneous Emphysema ◽  
Early Recognition ◽  
Growth Factor Receptor ◽  
Metastatic Colorectal Carcinoma ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Threatening Condition

Introduction Developments in targeted molecular therapies have considerably improved patient survival in cancer. Panitumumab is a monoclonal antibody against the epidermal growth factor receptor (EGFR). It is used to treat metastatic colorectal carcinoma. Although panitumumab is well tolerated in most patients, pulmonary toxicity, especially interstitial lung disease (ILD), is a life-threatening condition. The presentation of panitumumab-induced ILD with spontaneous pneumomediastinum and subcutaneous emphysema is rarely reported. Case report We describe a 61-year-old male with metastatic colorectal carcinoma treated with FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) and panitumumab. He presented to our hospital with a complaint of severe dyspnea. On the evaluation of dyspnea, the patient was diagnosed with ILD. Management and outcome After exclusion of other common causes of pneumomediastinum and subcutaneous emphysema, panitumumab was attributed as a cause of ILD. Oxygen therapy via high flow nasal cannula and intravenous methylprednisolone regimen was started. After two weeks, the patient became asymptomatic with the radiologic amelioration. Discussion Panitumumab-induced ILD is associated with a poor prognosis and might occur randomly in one year after the drug administration. The possibility of the disease should be considered on every admission. Early recognition, discontinuation of causative medication, and immediate glucocorticoid therapy are essential to reduce mortality.

Successful retreatment with erlotinib after erlotinib-related interstitial lung disease

2021 ◽  
pp. 030089162110200
Author(s):  
Haci M. Turk ◽  
Mustafa Adli ◽  
Melih Simsek ◽  
Altay Aliyev ◽  
Mehmet Besiroglu
Keyword(s):  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Interstitial Lung Disease ◽  
Epidermal Growth Factor ◽  
Tyrosine Kinase ◽  
Lung Disease ◽  
Receptor Tyrosine Kinase ◽  
Kinase Inhibitors ◽  
Growth Factor Receptor ◽  
Epidermal Growth

Background: Epidermal growth factor receptor tyrosine kinase inhibitors are effectively being used in the treatment of non-small cell lung cancer. Although most of their adverse effects are mild to moderate, they occasionally can cause life-threatening interstitial lung disease. We aimed to present a case of lung adenocarcinoma successfully re-treated with erlotinib after recovery with effective treatment of erlotinib-induced interstitial lung disease. Case description: A 54-year-old nonsmoking woman was diagnosed with metastatic adenocarcinoma of the lung. After progression with first-line chemotherapy, erlotinib 150 mg daily was initiated. On the 45th day of erlotinib treatment, interstitial lung disease occurred and erlotinib was discontinued. Clinical improvement was achieved with dexamethasone treatment and erlotinib was re-initiated. Ten weeks after re-initiation of erlotinib, 100 mg daily partial response was observed. Conclusions: Incidence of interstitial lung disease is higher in men, smokers, and patients with pulmonary fibrosis. Interstitial lung disease radiologically causes ground-glass opacity and consolidation. The physician should quickly evaluate new respiratory symptoms in patients treated with epidermal growth factor receptor tyrosine kinase inhibitors, discontinue the epidermal growth factor receptor tyrosine kinase inhibitor treatment, and initiate corticosteroids if clinical diagnosis is interstitial lung disease.

Micronodular pattern organising pneumonia mimicking miliary lung disease: a rare radiological presentation

2021 ◽  
Vol 14 (2) ◽  
pp. e239856
Author(s):  
David Ng ◽  
Garun Hamilton ◽  
Eric Hu ◽  
Kenneth Lau
Keyword(s):  
Differential Diagnosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Hypersensitivity Pneumonitis ◽  
Imaging Findings ◽  
Review Of The Literature ◽  
Radiological Findings ◽  
Rare Presentation

Organising pneumonia (OP) is an interstitial lung disease characterised by granulation tissues in alveoli and alveolar ducts. Typical imaging findings are migratory airspace opacities with peripheral or peribronchovascular distribution. Diffuse micronodular OP (MNOP) is a rare imaging manifestation, which has imaging differential diagnosis of endobronchial infection such as tuberculosis, hypersensitivity pneumonitis and respiratory bronchiolitis. Although clinical and ancillary radiological findings may aid in refining the differential diagnosis, histopathological assessment is frequently required for this rare presentation due to implications of treatment and prognosis. We report a case of MNOP and performed a review of the literature.

scholarly journals Interstitial Lung Disease Associated with mTOR Inhibitors in Solid Organ Transplant Recipients: Results from a Large Phase III Clinical Trial Program of Everolimus and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Patricia Lopez ◽  
Sven Kohler ◽  
Seema Dimri
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
De Novo ◽  
Early Recognition ◽  
Mtor Inhibitors ◽  
Phase Iii ◽  
Drug Discontinuation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Phase Iii Trials

Interstitial lung disease (ILD) has been reported with the use of mammalian target of rapamycin inhibitors (mTORi). The clinical and safety databases of three Phase III trials of everolimus inde novokidney (A2309), heart (A2310), and liver (H2304) transplant recipients (TxR) were searched using a standardized MedDRA query (SMQ) search for ILD followed by a case-by-case medical evaluation. A literature search was conducted in MEDLINE and EMBASE. Out of the 1,473de novoTxR receiving everolimus in Phase III trials, everolimus-related ILD was confirmed in six cases (one kidney, four heart, and one liver TxR) representing an incidence of 0.4%. Everolimus was discontinued in three of the four heart TxR, resulting in ILD improvement or resolution. Outcome was fatal in the kidney TxR (in whom everolimus therapy was continued) and in the liver TxR despite everolimus discontinuation. The literature review identified 57 publications on ILD in solid organ TxR receiving everolimus or sirolimus. ILD presented months or years after mTORi initiation and symptoms were nonspecific and insidious. The event was more frequent in patients with a late switch to mTORi. In most cases, ILD was reversed after prompt mTORi discontinuation. ILD induced by mTORi is an uncommon and potentially fatal event warranting early recognition and drug discontinuation.

scholarly journals Adolescent-onset anti-MDA5 antibody-positive juvenile dermatomyositis with rapidly progressive interstitial lung disease and spontaneous pneumomediastinum: a case report and literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tsz-Wing Yeung ◽  
Kai-Ning Cheong ◽  
Yu-Lung Lau ◽  
Kei-Chiu Niko Tse
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Immunosuppressive Therapy ◽  
High Mortality ◽  
Inflammatory Myopathy ◽  
Unknown Etiology ◽  
Rapid Progression ◽  
Muscle Involvement ◽  
Spontaneous Pneumomediastinum ◽  
Increased Risk

Abstract Background Dermatomyositis with positive anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody has a distinct phenotype associated with small hand joint arthritis, mucocutaneous ulceration, palmar papules and less muscle involvement. It is also associated with increased risk of rapidly progressive interstitial lung disease (RP-ILD) and has a high mortality rate in adults. There is evidence that cases complicated with spontaneous pneumomediastinum (PNM) have an increase in mortality. While most of the evidence for this rare disease is derived from the adult literature, we report a case diagnosed in an adolescent complicated with both RP-ILD and PNM with a good outcome after aggressive immunosuppressive therapy. Our case also illustrates the potential challenges in diagnosis of this condition in the setting of non-specific clinical manifestations, the need for a high index of suspicion, and the importance of testing for myositis-specific antibodies (MSA) early to aid in diagnosis given the risk of rapid progression in these patients. Case presentation A 16-year-old Chinese female presented with fever and cough for 1 day, and finger swelling for 3 weeks. Physical examination revealed arthritis of fingers and wrists, ulcers and palmar papules over fingers, hyperpigmentation of interphalangeal joints, and rash over the neck. The diagnosis of dermatomyositis was made 1 month later with the onset of malar rash, Gottron’s papules, calcinosis and myalgia. The diagnosis was supported by the presence of anti-MDA5 antibody and evidence of inflammatory myopathy on magnetic resonance imaging. In retrospect, she already had interstitial lung disease at first presentation manifested as cough and opacity on chest radiograph, which was later confirmed with chest computed tomography. She was treated according to adult guidelines with steroid and calcineurin inhibitor. Her disease was resistant to initial therapy and was complicated by RP-ILD and spontaneous PNM. Intensive immunosuppressive therapy including cyclophosphamide and rituximab were required to induce remission. Conclusions Recognition of distinct clinical features of anti-MDA5 antibody-positive dermatomyositis and testing for MSA is crucial in patients with skin ulceration and abnormal pulmonary findings of unknown etiology, as prompt diagnosis with early aggressive treatment and anticipation of complications could make a difference in the outcome of this disease with high mortality.

Bedeutung von Myositis-spezifischen Autoantikörpern bei der Dermatomyositis und Lungenbeteiligung

2021 ◽  
Vol 3 (1) ◽  
pp. 17-18
Author(s):  
Michael Sticherling
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Subcutaneous Emphysema ◽  
Poor Prognosis ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Imaging Features ◽  
Amyopathic Dermatomyositis ◽  
Serological Tests ◽  
Medical University

<b>Objective:</b> To investigate the clinical characteristics of patients positive for anti-melanoma differentiation-associated gene 5 (MDA5) antibodies, and to analyse the potential pathogenesis of anti-MDA5 antibodies. <b>Methods:</b> The clinical manifestations, serological tests, imaging features, treatments, and prognoses of 32 anti-MDA5 antibody-positive patients diagnosed in the Rheumatology and Immunology Department of the Second Affiliated Hospital of Chongqing Medical University from September 2015 to August 2018 were analysed. <b>Results:</b> Of the 32 anti-MDA5 antibody-positive patients, eleven patients were clinically diagnosed with interstitial pneumonia with autoimmune features (IPAF), ten patients were diagnosed with clinically amyopathic dermatomyositis (CADM), six patients were diagnosed with dermatomyositis (DM) and five patients were diagnosed with anti-synthetase syndrome (ASS). Thirty patients had various degrees of pulmonary interstitial changes. The incidence of mortality, subcutaneous emphysema, hoarseness and dysphagia in patients who were positive for both anti-MDA5 and anti-Ro52 antibodies was significantly higher than in patients positive for only anti-MDA5 antibodies. The anti-MDA5 antibody-positive IPAF patients had a very poor prognosis, and mortality in these patients was as high as 54.55%. <b>Conclusion:</b> Anti-MDA5 antibodies are closely related to interstitial lung disease (ILD). The presence of both anti-MDA5 and anti-Ro52 antibodies indicates poor prognosis.

scholarly journals Diagnosis and treatment of drug-induced interstitial lung disease

2021 ◽  
Vol 64 (4) ◽  
pp. 286-295
Author(s):  
Sanghoon Park ◽  
Eun Joo Lee
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Clinical Symptoms ◽  
Checkpoint Inhibitors ◽  
Interstitial Fibrosis ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Drug Induced ◽  
Fibrotic Process ◽  
Epidermal Growth

Drug-induced interstitial lung disease (DILD) is a group of adverse drug reactions that is rare but fatally toxic. Pulmonary toxicity causes inflammation and subsequent interstitial fibrosis. As novel drugs with a variety of purposes are introduced into the medical field, the number of culprit medications that are suspected to cause lung complications is accordingly increasing. In this review, DILD will be discussed from several aspects such as causality by numerous drugs, check points for a timely diagnosis, alongside some contemporary treatment options. The exact mechanism of DILD has not been elucidated, and a useful clinical, radiological, or pathological confirmation process is still lacking. Common drugs which casue DILD include bleomycin, amiodarone, epidermal growth factor receptor-targeted agents, and immune checkpoint inhibitors. Diagnosis is based on a suspicious drug administration history, somewhat inconsistent clinical symptoms and signs, radiological hints, and histopathological assistance, together with the exclusion of other lung-injuring etiologies. Cessation of the suspected drug, meticulous corticosteroid usage, and ancillary supportive management are the mainstay therapeutic strategy for DILD. Most cases of DILD respond to these countermeasures and reductions, but in some cases the fibrotic process worsens, leading to irreversible sequelae on the affected lung.

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