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A37. CASE REPORTS: DRUG TOXICITY最新文献

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Pembrolizumab-Induced Sarcoidosis: A Case Report 派姆单抗致结节病1例报告
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1392
C. Walmsley, T. Sibert, S. Summers
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引用次数: 0
Chronic Eosinophilic Pneumonia - A Challenging Case with Multiple Triggers 慢性嗜酸性粒细胞性肺炎-一个具有多重触发因素的挑战性病例
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1391
F. Das Gracas, F. Nitol, K. Gafoor
Introduction Eosinophilic pneumonia is a class of lung diseases characterized by accumulation of eosinophils in the lung. Chronic eosinophilic pneumonia (CEP) is diagnosed through radiographic imaging and bronchoalveolar lavage (BAL) with elevated eosinophil count (>25%) in the setting of pulmonary symptoms for more than 2 weeks. While CEP is often an idiopathic disease, it may also be caused by medications, illicit substances, or infections. Identifying the trigger is imperative for successful treatment. A 71-year-old man presented with fever and chronic shortness of breath that started after COVID-19 infection (6 months prior to presentation). Medical history was also significant for multiple myeloma, asthma, hypertension, type 2 diabetes, coronary artery disease, chronic kidney disease, and Alzheimer's dementia. Current medications included bortezomib, pomalidomide, aspirin, clopidogrel , donepezil, tramadol and insulin. Lenalidomide was discontinued 3 months prior due to generalized skin rash and high peripheral eosinophilia (19%). On presentation, physical exam revealed mild respiratory distress, bibasilar crackles, and bilateral pedal edema. Long COVID Syndrome was suspected. He was started on antibiotics and diuretics with no improvement. Labs revealed mild peripheral eosinophilia. Chest X-ray showed diffuse bilateral reticular nodular opacities predominantly on the right. CT chest revealed reticulonodular infiltrates in both lungs predominantly in the right upper lobe with small pleural effusion. Bronchoscopy with BAL was negative for infection but revealed 28% eosinophils. Pomalidomide was discontinued and oral prednisone started. Discussion: CEP is part of a group of eosinophilic lung diseases characterized by abnormal accumulation of eosinophils in the lung tissue. Symptoms include dyspnea and cough in the majority of cases, but may also include fever, sinusitis, rhinitis, fatigue and weight loss. The radiographic hallmarks are bilateral alveolar infiltrates peripherally predominantly in the upper lobes and may be ground glass or consolidation. The presence of an elevated eosinophil count (>25%) in a BAL confirms the diagnosis. Though often idiopathic, identification of possible causes is important for proper management. In our case, the patient has multiple risk factors including possible Long COVID Syndrome and malignancy. Medications such as bortezomib, lenalinomide and pomalidomide have been known to cause diffuse lung injury. To the best of our knowledge there is one case report illustrating Lenalinomide related CEP. History of asthma is present in most cases of idiopathic CEP. Our patient had multiple potential triggers for CEP. We suspect that CEP was medication-related in this case. (Figure Presented).
嗜酸性粒细胞性肺炎是一类肺部疾病,其特征是肺内嗜酸性粒细胞积聚。慢性嗜酸性肺炎(CEP)是在肺部症状超过2周的情况下,通过影像学检查和支气管肺泡灌洗(BAL)诊断嗜酸性粒细胞计数升高(>25%)。虽然CEP通常是一种特发性疾病,但它也可能由药物、非法物质或感染引起。确定诱发因素对成功治疗至关重要。一名71岁男性在COVID-19感染后(发病前6个月)出现发烧和慢性呼吸短促。多发性骨髓瘤、哮喘、高血压、2型糖尿病、冠状动脉疾病、慢性肾脏疾病和阿尔茨海默氏痴呆症的病史也很重要。目前的药物包括硼替佐米、泊马度胺、阿司匹林、氯吡格雷、多奈哌齐、曲马多和胰岛素。来那度胺因全身性皮疹和高外周嗜酸性粒细胞增多(19%)在3个月前停用。就诊时,体格检查显示轻度呼吸窘迫,双基底肌脆裂,双足水肿。疑似长冠综合征。他开始服用抗生素和利尿剂,但没有好转。实验室显示轻度外周嗜酸性粒细胞增多。胸部x线显示弥漫性双侧网状结节性影,主要在右侧。胸部CT示双肺网状结节浸润,以右上肺叶为主,伴少量胸腔积液。BAL支气管镜检查感染阴性,但发现28%的嗜酸性粒细胞。停用波马度胺,开始口服强的松。讨论:CEP是一组以肺组织中嗜酸性粒细胞异常积聚为特征的嗜酸性粒细胞肺病的一部分。大多数病例的症状包括呼吸困难和咳嗽,但也可能包括发烧、鼻窦炎、鼻炎、疲劳和体重减轻。x线表现为双侧肺泡浸润,主要分布在肺上叶周围,可能为磨玻璃或实变。BAL中嗜酸性粒细胞计数升高(>25%)证实了诊断。虽然通常是特发性的,但确定可能的原因对于适当的治疗很重要。在我们的病例中,患者有多种危险因素,包括可能的长冠状病毒综合征和恶性肿瘤。硼替佐米、来那利胺和泊马度胺等药物可引起弥漫性肺损伤。据我们所知,有一个病例报告说明来那胺相关的CEP。大多数特发性CEP病例均有哮喘史。我们的病人有多种CEP的潜在诱因。我们怀疑在这个病例中CEP与药物有关。(图)。
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引用次数: 0
Not All That Is Pneumocystis Jirovecii Pneumonia (PCP) Is HIV: A Case of Drug Predisposed PCP Due to Initiation of Tocilizumab in an HIV Negative Patient 并非所有的肺囊虫肺炎(PCP)都是HIV:一个HIV阴性患者开始使用托珠单抗导致药物易感性PCP的病例
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1394
D. Walsh, N. Ravikumar
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引用次数: 0
Dasatinib Induced Pneumonitis 达沙替尼引起的肺炎
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1412
S. Chandna, M. Shah, K. Raj, S. Bhasin, D. Ngo
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引用次数: 0
A Case of Hydroxyurea-Induced Interstitial Pneumonitis 羟基脲所致间质性肺炎1例
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1393
C. Williams, S. Patel, N. McDonald, V. Patel
Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile.
简介:羟基脲于1869年首次合成,以其治疗骨髓增生性疾病、宫颈癌和镰状细胞病的功效而闻名。羟基脲通常耐受性良好,但有许多不良反应,包括骨髓抑制、发烧、胃肠不适、厌食和黄斑丘疹。此外,一种罕见的副作用是间质性肺炎,如果忽视,这可能是一种毁灭性的并发症。我们报告一例羟基脲引起的间质性肺炎。病例描述:一名65岁男性,6个月诊断为慢性粒细胞白血病(CGL),经羟基脲治疗后出现急性低氧血症性呼吸衰竭,室内空气饱和度为80%,HR 102, RR 24,需氧量增加(10 Lpm),入院时主述呼吸困难加重,疲劳,咳嗽伴黄/绿痰。查体表现为恶病质、病征、全身无力、声音沙哑、心动过速、呼吸急促、弥漫性呼吸音减弱、肺野听诊散在啰音。初步影像学表现为胸片双侧空域疾病、肺混浊、双侧肺炎(涉及COVID-19肺炎)、纵隔腺病、胸部计算机断层扫描脾肿大。实验室初步检查白细胞计数62.5 th/uL,乳酸性酸中毒2.5 mmol/L,降钙素原4.95 ng/mL, PCR检测阴性。鉴于可能的败血症,在收集血培养后立即开始万古霉素/头孢吡肟治疗。由于临床改善甚微,将鞭毛灵、伐昔洛韦和泊沙康唑与类固醇治疗一起添加到抗菌药物覆盖范围内。在BiPAP和加热高流量鼻插管(FiO2在70-85%之间)交替进行的显著耗氧性心动过速持续存在。每日影像学也显示空域疾病恶化。病毒、细菌和真菌培养阴性导致随后因怀疑药物性肺炎而停止羟基脲治疗。停用羟基脲3天后,患者的需氧量开始下降,影像学显示在没有抗菌药物治疗的情况下肺炎变化的间隔分辨率。在出院前,患者被转移到Ruxolitinib治疗其潜在的CGL,而不需要家庭氧气治疗。讨论:羟基脲肺毒性被认为是由过敏性肺炎引起的,很容易被误诊。不幸的是,虽然羟基脲对全细胞减少、胃肠道和皮肤的副作用已知很多,但文献中很少有病例强调羟基脲引起的潜在致命性间质性肺炎,1999年首次报道。因此,本病例为详细描述羟基脲肺部不良副作用的文献提供了额外的贡献。(图)。
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引用次数: 0
When Ou Gon Too Far: A Cautionary Tale of Supplement Use 当你走得太远:服用补品的警世故事
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1390
M. Forster, C. Motschwiller, M. F. Sloane
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引用次数: 0
A Case of Organizing Pneumonia Developed After COVID-19 Vaccine 1例新型冠状病毒疫苗接种后发生的组织性肺炎
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1417
J. Ryoo, H. Cho, J. Lee, C. Rhee, S.J. Kim, S. Kim, S. Lee, Y. Kim, J. Kang
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引用次数: 0
Vaping Induce Pneumonitis: Missed in Pandemic 电子烟诱发肺炎:在大流行中未被发现
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1400
A. Iftikhar, M. Patel, M. Cheema, A. Adial
Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly emergent coronavirus, that was first recognized in Wuhan, Hubei province, China, in December 2019. SARS-CoV-2 is a positive-sense singlestranded RNA virus that is contagious in humans. E-cigarette or vaping product use-associated lung injury (EVALI) is a type of acute lung injury of unclear pathogenesis. The two pathologies present with overlapping clinical symptoms, and imaging, making them difficult to distinguish, especially in global COVID-19 pandemic. Case report: 27-year-old female with past medical history of IBS, Diverticulitis, and anxiety presented with cough, shortness of breath, fever and fatigue. She also reported headaches and abdominal pain, she denies sick contact and recent travel but admit that she uses E cigarette more than usual due to anxiety attack. Patients initially discharge from ED but subsequently admit to hospital for worsening of symptoms possible COVID pneumonia vs community acquired pneumonia. She was persistently hypoxic and transfer to ICU for acute hypoxic respiratory failure. Labs was significant for elevated WBC while serum chemistries were unremarkable, Chest x-ray was not significant for any acute pathology. CT scan show revealed parenchymal changes consistent with bilateral upper and lower lobe ground-glass opacities. No septal change was noted, helping us rule out causes such as organizing pneumonia, lipoid pneumonia, and diffuse alveolar damage. Extensive testing for viral and bacterial infections was all negative. she has Covid19 PCR negative twice. Bronchoalveolar lavage testing was not done as patient refuse for invasive intervention. Patient started on steroids. Discussion: EVALI is thought to be a type of acute lung injury with an unknown pathogenesis. E-cigarette use, especially those containing THC and/or vitamin E acetate, is a key risk factor for developing the disease process. COVID 19 pneumonitis and EVALI have same clinical presentation, laboratory studies and images, and make challenge for physician to differentiate both pathologies. Both disease present with similar initial symptoms, including cough, shortness of breath, fevers, vomiting, diarrhea and headache. Similarly, laboratory studies may be unremarkable or elevated in both presentations and do not help distinguish between them. Furthermore, Chest X-ray and CT have very similar findings in both presentations, including diffuse hazy or consolidative opacities and ground-glass opacities, respectively. As well, both COVID-19 and EVALI are associated with worse outcomes in older adults or those with underlying chronic conditions, including cardiac and pulmonary disease.
2019冠状病毒病(COVID-19)是由2019年12月在中国湖北省武汉市首次发现的新型冠状病毒——严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)引起的。SARS-CoV-2是一种正感单链RNA病毒,在人类中具有传染性。电子烟或电子烟产品使用相关性肺损伤(EVALI)是一种发病机制尚不明确的急性肺损伤。两种病理表现出重叠的临床症状和影像学表现,使其难以区分,特别是在全球COVID-19大流行中。病例报告:27岁女性,既往有肠易激综合征、憩室炎、焦虑病史,表现为咳嗽、呼吸短促、发热、乏力。她还报告说头疼和腹痛,她否认生病接触和最近的旅行,但承认由于焦虑发作,她比平时更多地使用电子烟。患者最初从急诊科出院,但随后因症状恶化而入院,可能是COVID -肺炎与社区获得性肺炎。患者持续缺氧,因急性缺氧呼吸衰竭转至ICU。实验室检查显示白细胞升高,血清化学检查无明显变化,胸部x线检查显示急性病理无明显变化。CT显示实质改变与双侧上下叶磨玻璃影一致。未见鼻中隔改变,这有助于我们排除组织性肺炎、类脂性肺炎和弥漫性肺泡损伤等病因。广泛的病毒和细菌感染检测结果均为阴性。她的新冠病毒PCR结果两次呈阴性。支气管肺泡灌洗试验因患者拒绝介入治疗而未做。病人开始服用类固醇。讨论:EVALI被认为是一种发病机制未知的急性肺损伤。电子烟的使用,特别是那些含有四氢大麻酚和/或维生素E醋酸酯的电子烟,是发展疾病过程的一个关键风险因素。COVID - 19肺炎和EVALI具有相同的临床表现、实验室研究和图像,给医生区分这两种病理带来了挑战。两种疾病的初始症状相似,包括咳嗽、呼吸短促、发烧、呕吐、腹泻和头痛。同样,实验室研究可能在两种表现中都不显著或升高,并不能帮助区分它们。此外,胸片和CT的表现非常相似,分别包括弥漫性朦胧或实变性混浊和磨玻璃混浊。此外,COVID-19和EVALI都与老年人或患有潜在慢性病(包括心脏和肺部疾病)的患者的预后较差有关。
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引用次数: 0
Sarcoidosis-Like Reaction Secondary to Infliximab 英夫利昔单抗继发的结节病样反应
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1421
P. M. Cavalcante Neto, M. R. Soares, M. Castro, S.L.K. Matias, A. Resende, S.A.E.H.C. Silva, M. Cerezoli, G. Miranda, C. Fukuda, V. Arida, R. Ferreira, I. Missrie, C. Pereira
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引用次数: 0
A Case of Leflunomide-Induced Pulmonary Nodulosis 来氟米特致肺结节病1例
Pub Date : 2022-05-01 DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1409
R. Gómez, S. Wong
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引用次数: 0
期刊
A37. CASE REPORTS: DRUG TOXICITY
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