Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1405
J. Odonnell, K. Anacker, J. Giudice, J. Chiaffarano
{"title":"Unilateral Pneumonitis as a Complication of Amiodarone Toxicity","authors":"J. Odonnell, K. Anacker, J. Giudice, J. Chiaffarano","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1405","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1405","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121615352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1407
R. Sanivarapu, Bhanusivakumar R. Sabbula, J. Kang, M. Joy, J. Akella, J. Iqbal
{"title":"Vandetanib Induced Diffuse Interstitial Lung Disease","authors":"R. Sanivarapu, Bhanusivakumar R. Sabbula, J. Kang, M. Joy, J. Akella, J. Iqbal","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1407","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1407","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124248659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1411
R. Chan, P. Sakhamuri, S. Walker
Introduction: The known etiologies of acute eosinophilic pneumonia (AEP) have grown recently, culminating in the creation of the term drug-induced AEP 3. One of the newer causes of druginduced AEP is Daptomycin, which has grown in popularity for its use in treating methicillin-resistant staph aureus (MRSA) infections. As a result, the Food Drug Administration created the following criteria to diagnosis Daptomycin-induced AEP: 1) concurrent exposure to Daptomycin, 2) fever, 3) dyspnea with increased oxygen requirement or requiring mechanical ventilation, 4) new infiltrates on imaging, 5) bronchoalveolar lavage (BAL) with >25% eosinophils and 6) clinical improvement following Daptomycin withdrawal. Given this statement, we present a case of Daptomycin-induced AEP. Case Presentation: A 45-year old female presented to the ER with a complaint of shortness of breath for four days. She had recently been diagnosed with Covid-19 with concomitant globicatella bacteremia and discharged 17 days ago with home oxygen (requiring 3L) and to complete 2 weeks of IV Daptomycin. In the ER, a CT Angio Chest was obtained showing bilateral airspace opacities with no evidence of thromboembolism. She was also noted to be saturating at 92% while on 15L Venturi-mask. The patient was started on broad-spectrum antibiotics and cultures were obtained. Her condition worsened and a bronchoscopy with bronchoalveolar lavage (BAL) was performed, however there was inadequate specimen to run cytology. Due to worsening status despite antibiotics, the patient was started on methylprednisolone 80 mg three times a day. After initiation of steroids, the patient's respiratory status returned to baseline and repeat imaging showed improvements of opacities. Complete infectious and autoimmune workups were complete ruling out other etiologies. The patient was discharged with a steroid taper and repeat CT imaging ordered, but never done. Discussion: Though we were unable to obtain a BAL specimen, we are confident of our diagnosis. Our patient not only had a known inciting factor, but also had resolution of symptoms with withdrawal of Daptomycin and initiation of steroids. Our case study highlights two important points about the disease. First, AEP should be on the differential for patients with a complaint of shortness of breath with a known inciting factor. Secondly, it should be noted that while our patient was unable to meet all criteria created by the FDA, this should not rule out the diagnosis. It is important to be proactive in treatment if clinical suspicion is high.
{"title":"Daptomycin-Induced Eosinophilic Pneumonia","authors":"R. Chan, P. Sakhamuri, S. Walker","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1411","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1411","url":null,"abstract":"Introduction: The known etiologies of acute eosinophilic pneumonia (AEP) have grown recently, culminating in the creation of the term drug-induced AEP 3. One of the newer causes of druginduced AEP is Daptomycin, which has grown in popularity for its use in treating methicillin-resistant staph aureus (MRSA) infections. As a result, the Food Drug Administration created the following criteria to diagnosis Daptomycin-induced AEP: 1) concurrent exposure to Daptomycin, 2) fever, 3) dyspnea with increased oxygen requirement or requiring mechanical ventilation, 4) new infiltrates on imaging, 5) bronchoalveolar lavage (BAL) with >25% eosinophils and 6) clinical improvement following Daptomycin withdrawal. Given this statement, we present a case of Daptomycin-induced AEP. Case Presentation: A 45-year old female presented to the ER with a complaint of shortness of breath for four days. She had recently been diagnosed with Covid-19 with concomitant globicatella bacteremia and discharged 17 days ago with home oxygen (requiring 3L) and to complete 2 weeks of IV Daptomycin. In the ER, a CT Angio Chest was obtained showing bilateral airspace opacities with no evidence of thromboembolism. She was also noted to be saturating at 92% while on 15L Venturi-mask. The patient was started on broad-spectrum antibiotics and cultures were obtained. Her condition worsened and a bronchoscopy with bronchoalveolar lavage (BAL) was performed, however there was inadequate specimen to run cytology. Due to worsening status despite antibiotics, the patient was started on methylprednisolone 80 mg three times a day. After initiation of steroids, the patient's respiratory status returned to baseline and repeat imaging showed improvements of opacities. Complete infectious and autoimmune workups were complete ruling out other etiologies. The patient was discharged with a steroid taper and repeat CT imaging ordered, but never done. Discussion: Though we were unable to obtain a BAL specimen, we are confident of our diagnosis. Our patient not only had a known inciting factor, but also had resolution of symptoms with withdrawal of Daptomycin and initiation of steroids. Our case study highlights two important points about the disease. First, AEP should be on the differential for patients with a complaint of shortness of breath with a known inciting factor. Secondly, it should be noted that while our patient was unable to meet all criteria created by the FDA, this should not rule out the diagnosis. It is important to be proactive in treatment if clinical suspicion is high.","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"24 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120845033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1403
V. Pulivarthi, S. S. Vulasala, R. Herrera
Introduction: Methamphetamine can cause toxic lung parenchymal injury irrespective of frequency of use. It is important for physicians to be aware of methamphetamine associated lung injury as a differential diagnosis of acute respiratory distress in the era of COVID pandemic. Here we discussed a case of methamphetamine induced pneumonitis and its management. Case description: A 35-year-old female with history of pulmonary coccidiomycosis s/p treatment 15 years ago, ex-smoker (quit 8 years ago), unvaccinated for COVID-19 presented with two weeks of progressively worsening shortness of breath, fever, chills, generalized body aches, sore throat with hoarseness of voice, nonproductive cough, wheezing and midsternal chest pain. On presentation, vitals were significant for hypoxia with SpO2 84% requiring 2L of nasal canula, sinus tachycardia to 109, tachypneic in 30s. Physical exam showed stridor and bilateral diffuse expiratory wheezing. Stridor improved with racemic epinephrine and dexamethasone 10mg IV. CBC, CMP, Procalcitonin, BNP, COVID-19 and Respiratory PCR were negative, while coccidioidomycosis antibody was positive. UDS was positive for methamphetamine. Chest X-ray showed features of atypical pneumonitis. CT Chest showed similar findings and was negative for pulmonary embolism. She was managed symptomatically with albuterol inhaler. Respiratory symptoms improved during hospitalization without any further interventions. Discussion: According to National Survey on Drug Use and Health in 2018, 1.6million people (age >26years) used methamphetamine in one year which is 0.5% more than 2016-2017. Crystalline methamphetamine is a widely used inhaled stimulant with few reported cases of acute respiratory distress syndrome, eosinophilic pneumonia, pneumonitis, and diffuse alveolar hemorrhage. Even though mechanism of injury is unclear in human beings, toxicity was studied in animals. Chronic methamphetamine use causes thickened alveolar walls and reduced alveolar sacs by oxidative stress and by increased free radial formation. Patients often present with non-specific symptoms including cough, short of breath, sore throat or chest pain. The temporal relation of symptomatology with methamphetamine use and exclusion of infectious and other pulmonary etiology based on labs and radiological findings is crucial in establishing the diagnosis. Early diagnosis, symptomatic treatment and cessation of substance use are core management. Conclusion: We discussed a case of methamphetamine induced pneumonitis, who presented with upper and lower respiratory symptoms that resolved dramatically with the early diagnosis and supportive care. We recommend to consider methamphetamine induced lung injury as a differential diagnosis in patients with risk factor of illicit drug use, especially in the era of COVID-19 pandemic for early diagnosis and appropriate management. (Figure Presented).
{"title":"Management of Methamphetamine Induced Pneumonitis","authors":"V. Pulivarthi, S. S. Vulasala, R. Herrera","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1403","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1403","url":null,"abstract":"Introduction: Methamphetamine can cause toxic lung parenchymal injury irrespective of frequency of use. It is important for physicians to be aware of methamphetamine associated lung injury as a differential diagnosis of acute respiratory distress in the era of COVID pandemic. Here we discussed a case of methamphetamine induced pneumonitis and its management. Case description: A 35-year-old female with history of pulmonary coccidiomycosis s/p treatment 15 years ago, ex-smoker (quit 8 years ago), unvaccinated for COVID-19 presented with two weeks of progressively worsening shortness of breath, fever, chills, generalized body aches, sore throat with hoarseness of voice, nonproductive cough, wheezing and midsternal chest pain. On presentation, vitals were significant for hypoxia with SpO2 84% requiring 2L of nasal canula, sinus tachycardia to 109, tachypneic in 30s. Physical exam showed stridor and bilateral diffuse expiratory wheezing. Stridor improved with racemic epinephrine and dexamethasone 10mg IV. CBC, CMP, Procalcitonin, BNP, COVID-19 and Respiratory PCR were negative, while coccidioidomycosis antibody was positive. UDS was positive for methamphetamine. Chest X-ray showed features of atypical pneumonitis. CT Chest showed similar findings and was negative for pulmonary embolism. She was managed symptomatically with albuterol inhaler. Respiratory symptoms improved during hospitalization without any further interventions. Discussion: According to National Survey on Drug Use and Health in 2018, 1.6million people (age >26years) used methamphetamine in one year which is 0.5% more than 2016-2017. Crystalline methamphetamine is a widely used inhaled stimulant with few reported cases of acute respiratory distress syndrome, eosinophilic pneumonia, pneumonitis, and diffuse alveolar hemorrhage. Even though mechanism of injury is unclear in human beings, toxicity was studied in animals. Chronic methamphetamine use causes thickened alveolar walls and reduced alveolar sacs by oxidative stress and by increased free radial formation. Patients often present with non-specific symptoms including cough, short of breath, sore throat or chest pain. The temporal relation of symptomatology with methamphetamine use and exclusion of infectious and other pulmonary etiology based on labs and radiological findings is crucial in establishing the diagnosis. Early diagnosis, symptomatic treatment and cessation of substance use are core management. Conclusion: We discussed a case of methamphetamine induced pneumonitis, who presented with upper and lower respiratory symptoms that resolved dramatically with the early diagnosis and supportive care. We recommend to consider methamphetamine induced lung injury as a differential diagnosis in patients with risk factor of illicit drug use, especially in the era of COVID-19 pandemic for early diagnosis and appropriate management. (Figure Presented).","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"159 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116210524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1402
J. Sohn, A. Ramaniuk, S. Hadigal
{"title":"Taxane Induced Interstitial Pneumonitis","authors":"J. Sohn, A. Ramaniuk, S. Hadigal","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1402","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1402","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131715748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1415
L. Ramdhanie, A. Daya, F. Nitol, K. Cervellione
Cocaine use has a significant public health impact, causing over 1.2 million ER visits annually. Cocaine can cause a wide range of pulmonary pathology, including diffuse alveolar hemorrhage (“Crack Lung”), barotrauma, bronchiectasis, granulomatous disease, and pulmonary vascular disease. Acute eosinophilic pneumonia (AEP) is a rare and potentially life-threatening complication of cocaine use that can be successfully treated if identified. We describe a case of persistent fevers, hypoxemia, and air space opacities due to AEP related to cocaine use.A 34-year-old male with a history of polysubstance abuse was found unresponsive, apneic, and surrounded by vomitus at a party, where he had smoked marijuana and cocaine and injected heroin. Upon hospital arrival, he was hypotensive and severely hypoxic and was intubated. He had severe rhabdomyolysis, lactic acidosis, acute kidney injury, and acute liver injury. His chest radiograph demonstrated diffuse bilateral alveolar infiltrates. COVID-19 was ruled out. Sputum cultures grew Klebsiella and E. Coli;Streptococcus Pneumoniae urine antigen was positive. He received IV fluids, vasopressors, and broad spectrum antibiotics for septic shock and aspiration pneumonia in the setting of drug overdose. His septic shock and hypoxemia improved, allowing tracheostomy and gastrostomy to be performed. Despite prolonged courses of antibiotics, he had persistent fevers, worsening infiltrates on chest radiograph, and persistent hypoxemia. CT imaging demonstrated diffuse, bilateral ground glass opacities and consolidations, with reticulation and interlobular septal thickening. Viral, bacterial, and fungal cultures collected via bronchoscopy were negative, however, cell count revealed 315 WBC / mm3, with 27% eosinophils. He was started on methylprednisolone 80mg IV every eight hours and had resolution of fevers and improvement in oxygenation and infiltrates. 1 month after discharge, he was decannulated and did not require supplemental oxygen. DiscussionThis case highlights an important aspect of assessing fever in the ICU despite broad spectrum antibiotics in patient with drug overdose. In the above , bronchoscopy unmasked an eosinophilic pneumonia allowing a rapid transition to trach collar and prevention of progression to pulmonary fibrosis. (Figure Presented).
{"title":"Uncovering Cocaine Induced Eosinophilic Pneumonia","authors":"L. Ramdhanie, A. Daya, F. Nitol, K. Cervellione","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1415","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1415","url":null,"abstract":"Cocaine use has a significant public health impact, causing over 1.2 million ER visits annually. Cocaine can cause a wide range of pulmonary pathology, including diffuse alveolar hemorrhage (“Crack Lung”), barotrauma, bronchiectasis, granulomatous disease, and pulmonary vascular disease. Acute eosinophilic pneumonia (AEP) is a rare and potentially life-threatening complication of cocaine use that can be successfully treated if identified. We describe a case of persistent fevers, hypoxemia, and air space opacities due to AEP related to cocaine use.A 34-year-old male with a history of polysubstance abuse was found unresponsive, apneic, and surrounded by vomitus at a party, where he had smoked marijuana and cocaine and injected heroin. Upon hospital arrival, he was hypotensive and severely hypoxic and was intubated. He had severe rhabdomyolysis, lactic acidosis, acute kidney injury, and acute liver injury. His chest radiograph demonstrated diffuse bilateral alveolar infiltrates. COVID-19 was ruled out. Sputum cultures grew Klebsiella and E. Coli;Streptococcus Pneumoniae urine antigen was positive. He received IV fluids, vasopressors, and broad spectrum antibiotics for septic shock and aspiration pneumonia in the setting of drug overdose. His septic shock and hypoxemia improved, allowing tracheostomy and gastrostomy to be performed. Despite prolonged courses of antibiotics, he had persistent fevers, worsening infiltrates on chest radiograph, and persistent hypoxemia. CT imaging demonstrated diffuse, bilateral ground glass opacities and consolidations, with reticulation and interlobular septal thickening. Viral, bacterial, and fungal cultures collected via bronchoscopy were negative, however, cell count revealed 315 WBC / mm3, with 27% eosinophils. He was started on methylprednisolone 80mg IV every eight hours and had resolution of fevers and improvement in oxygenation and infiltrates. 1 month after discharge, he was decannulated and did not require supplemental oxygen. DiscussionThis case highlights an important aspect of assessing fever in the ICU despite broad spectrum antibiotics in patient with drug overdose. In the above , bronchoscopy unmasked an eosinophilic pneumonia allowing a rapid transition to trach collar and prevention of progression to pulmonary fibrosis. (Figure Presented).","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131111457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1396
A. Devarajan, N. Azadeh
{"title":"A Rare Case of Capecitabine Superimposed with Adalimumab: Drug Induced Eosinophilic Pneumonia","authors":"A. Devarajan, N. Azadeh","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1396","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1396","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134178526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1419
G. Yoshikawa, M. Chock, G. Devendra
Introduction Immune thrombocytopenia (ITP) is an acquired thrombocytopenia due to autoantibodies. Eltrombopag is a thrombopoietin receptor agonist (TPO-RA) used as a second-line agent in the setting of persistent or chronic ITP. Potential severe adverse effects include hepatotoxicity, thromboembolism, and increased risk of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Upper respiratory infections and pharyngitis have also been described, but to our knowledge, no known cases of eltrombopag-induced pneumonitis have been reported to date. Case Presentation We present a 68-year-old male with a history of recent onset ITP, stage IV mantle cell lymphoma (in remission), and Pneumocystis pneumonia who was initiated on eltrombopag 11 days prior to admission for ITP refractory to corticosteroid therapy. Three weeks prior to admission, the patient underwent a bone marrow biopsy without evidence of monoclonal B cells or immunophenotypically abnormal T cell populations. Following initiation of eltrombopag, the patient had progressive dyspnea on exertion associated with subjective fevers and chills requiring hospitalization. Oxygen saturation was 88% on room air with exam notable for coarse crackles to the bilateral lung bases. CT angiogram of the chest revealed bilateral pulmonary emphysema, ground glass opacities, and bilateral bronchiectasis most pronounced in the lower lobes (Figure 1). No pulmonary embolism or mediastinal adenopathy was identified. Cytomegalovirus DNA, aspergillus antigen, and COVID-19 NAAT testing were negative. A respiratory viral panel was positive for Rhinovirus. Bronchoalveolar lavage (BAL) and right middle lobe lung parenchymal biopsy were subsequently performed. Pathology demonstrated focal intra-alveolar organization and fibroblast plugs, interstitial fibrosis, pneumocyte hyperplasia, and mixed (predominantly chronic) inflammatory infiltrate (Figure 2a & 2b). BAL was negative for malignant cells. Pneumocystis jirovecii DNA was detected, but < 250 copies/mL were identified and thus was thought to be less likely contributing to the disease process.Given the suspicion for eltrombopag-induced pneumonitis, the patient was initiated on high-dose corticosteroid therapy with a slow taper over the span of several weeks. Following initiation of corticosteroids, the patient was noted to have gradual improvement in his respiratory status. The patient was ultimately discharged on room air 1 month later due to other hematologic complications necessitating a prolonged hospital stay. Discussion The exact mechanism of eltrombopag-induced pneumonitis is unclear, although we postulate that it is related to an exaggerated immune response involving T-cell homeostasis resulting in alveolarcapillary permeability, inflammation, and fibrosis. Suspicion for eltrombopag-induced pneumonitis should prompt initiation of early corticosteroid therapy to prevent acute and chronic complications of pneumonitis. (Figure Presented).
{"title":"A Rare Case of Eltrombopag-Induced Pneumonitis","authors":"G. Yoshikawa, M. Chock, G. Devendra","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1419","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1419","url":null,"abstract":"Introduction Immune thrombocytopenia (ITP) is an acquired thrombocytopenia due to autoantibodies. Eltrombopag is a thrombopoietin receptor agonist (TPO-RA) used as a second-line agent in the setting of persistent or chronic ITP. Potential severe adverse effects include hepatotoxicity, thromboembolism, and increased risk of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Upper respiratory infections and pharyngitis have also been described, but to our knowledge, no known cases of eltrombopag-induced pneumonitis have been reported to date. Case Presentation We present a 68-year-old male with a history of recent onset ITP, stage IV mantle cell lymphoma (in remission), and Pneumocystis pneumonia who was initiated on eltrombopag 11 days prior to admission for ITP refractory to corticosteroid therapy. Three weeks prior to admission, the patient underwent a bone marrow biopsy without evidence of monoclonal B cells or immunophenotypically abnormal T cell populations. Following initiation of eltrombopag, the patient had progressive dyspnea on exertion associated with subjective fevers and chills requiring hospitalization. Oxygen saturation was 88% on room air with exam notable for coarse crackles to the bilateral lung bases. CT angiogram of the chest revealed bilateral pulmonary emphysema, ground glass opacities, and bilateral bronchiectasis most pronounced in the lower lobes (Figure 1). No pulmonary embolism or mediastinal adenopathy was identified. Cytomegalovirus DNA, aspergillus antigen, and COVID-19 NAAT testing were negative. A respiratory viral panel was positive for Rhinovirus. Bronchoalveolar lavage (BAL) and right middle lobe lung parenchymal biopsy were subsequently performed. Pathology demonstrated focal intra-alveolar organization and fibroblast plugs, interstitial fibrosis, pneumocyte hyperplasia, and mixed (predominantly chronic) inflammatory infiltrate (Figure 2a & 2b). BAL was negative for malignant cells. Pneumocystis jirovecii DNA was detected, but < 250 copies/mL were identified and thus was thought to be less likely contributing to the disease process.Given the suspicion for eltrombopag-induced pneumonitis, the patient was initiated on high-dose corticosteroid therapy with a slow taper over the span of several weeks. Following initiation of corticosteroids, the patient was noted to have gradual improvement in his respiratory status. The patient was ultimately discharged on room air 1 month later due to other hematologic complications necessitating a prolonged hospital stay. Discussion The exact mechanism of eltrombopag-induced pneumonitis is unclear, although we postulate that it is related to an exaggerated immune response involving T-cell homeostasis resulting in alveolarcapillary permeability, inflammation, and fibrosis. Suspicion for eltrombopag-induced pneumonitis should prompt initiation of early corticosteroid therapy to prevent acute and chronic complications of pneumonitis. (Figure Presented).","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132776720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1398
J. Moore, S. Margolskee, H. Bakhtiar
Palbociclib, abemaciclib and ribociclib are cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors used in the current treatment of HR-positive, HER2-negative metastatic breast cancer.1.2 As CDK 4/6 inhibitors are becoming more common it is important to be aware of some potentially fatal side effects. A 54-year-old woman with stage III breast cancer with prior mastectomy currently on hormonal and immunotherapy with anastrozole, ribociclib and goserelin presented with fever and shortness of breath. The patient became febrile with a negative COVID-19 test, and was treated for community acquired pneumonia. The fevers persisted despite antibiotics. CBC notable for leukopenia and uptrending absolute eosinophil count of 280 cells per microlitre. A chest CT scan revealed scattered, predominantly peripheral ground glass opacities in the bilateral upper, bilateral lower, and right middle lobes not present on prior imaging. A diagnostic bronchoscopy with BAL revealed 140 white-blood cells, 4 polys, 60 lymphocytes, 30 monocytes and 6 eosinophils. Flow cytometry yielded predominantly T-cells, abundant macrophages and inflammatory Infectious work up including PCP PCR, gram stain, fungal and AFB culture were negative. Ribociclib was discontinued and the patient improved symptomatically with return to baseline level of function. Reports of CDK 4/6 inhibitor drug-associated lung injury are limited There has been only one case report outside of clinical trials of Ribociclib pneumonitis.7 As these drugs become more commonly used, it is important for clinicians to be aware of this potentially fatal drug associated lung injury. Treatment with drug cessation has varying responses from recovery like in our patient to death.
{"title":"A Case Report of Ribociclib-Induced Pneumonitis","authors":"J. Moore, S. Margolskee, H. Bakhtiar","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1398","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1398","url":null,"abstract":"Palbociclib, abemaciclib and ribociclib are cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors used in the current treatment of HR-positive, HER2-negative metastatic breast cancer.1.2 As CDK 4/6 inhibitors are becoming more common it is important to be aware of some potentially fatal side effects. A 54-year-old woman with stage III breast cancer with prior mastectomy currently on hormonal and immunotherapy with anastrozole, ribociclib and goserelin presented with fever and shortness of breath. The patient became febrile with a negative COVID-19 test, and was treated for community acquired pneumonia. The fevers persisted despite antibiotics. CBC notable for leukopenia and uptrending absolute eosinophil count of 280 cells per microlitre. A chest CT scan revealed scattered, predominantly peripheral ground glass opacities in the bilateral upper, bilateral lower, and right middle lobes not present on prior imaging. A diagnostic bronchoscopy with BAL revealed 140 white-blood cells, 4 polys, 60 lymphocytes, 30 monocytes and 6 eosinophils. Flow cytometry yielded predominantly T-cells, abundant macrophages and inflammatory Infectious work up including PCP PCR, gram stain, fungal and AFB culture were negative. Ribociclib was discontinued and the patient improved symptomatically with return to baseline level of function. Reports of CDK 4/6 inhibitor drug-associated lung injury are limited There has been only one case report outside of clinical trials of Ribociclib pneumonitis.7 As these drugs become more commonly used, it is important for clinicians to be aware of this potentially fatal drug associated lung injury. Treatment with drug cessation has varying responses from recovery like in our patient to death.","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127289196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1401
K. Shah, J. Ruiz Vega, J. Pham, J. Salazar Castillo, N. Rodriguez
{"title":"A Rare Case of Palbociclib Induced Pneumonitis","authors":"K. Shah, J. Ruiz Vega, J. Pham, J. Salazar Castillo, N. Rodriguez","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1401","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1401","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120960732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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