Diffuse Lung Disease: Student/Resident Case Report Poster - Diffuse Lung Disease |

Oxaliplatin-Induced Interstitial Lung Disease FREE TO VIEW

Lydia Winnicka, MD; Crystal Duran, MD; Charumathi Raghu Subramanian, MD
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Guthrie Clinic, Sayre, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):524A. doi:10.1016/j.chest.2016.08.538
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SESSION TITLE: Student/Resident Case Report Poster - Diffuse Lung Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Drug-induced interstitial lung disease (DILD) is a difficult diagnosis as it requires a high index of suspicion and presents with non-specific symptoms. DILD is idiosyncratic, runs an unpredictable course, and there are no definitive diagnostic tests.1 First implicated in 2005, oxaliplatin is increasingly being recognized as an important cause of DILD.2

CASE PRESENTATION: A 62 year old female with a history of colon cancer on FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) presented with cough and shortness of breath on Dec. 25th, 2015. She was noted to have 3 admissions for pneumonia between Oct. 2015 and Dec. 2015. She was treated with antibiotics but never had complete recovery and eventually became O2-dependent. She continued FOLFOX and began cycle 10 on Dec. 2nd,2015. She was admitted a 4th time on Dec. 25th, 2015. She had persistent cough, purulent sputum, and was hypoxemic. CT chest revealed progression of bilateral interstitial opacities and new diffuse groundglass opacities as compared to CT chest Dec. 7th. She underwent VATS with right lower lobe biopsy on day 5. Pathology revealed interstitial thickening and active fibroblastic proliferation with type-2 pneumocyte hyperplasia and intra-alveolar fibrin deposition. Findings were consistent with diffuse alveolar damage. All cultures were negative. Anti-nuclear antibody, rheumatoid factor, anti-citrullinated protein, anti-Ro/La, anti-RNP, and p- and c-ANCA were negative. Given the temporal relationship to oxaliplatin, a diagnosis of DILD was made. She was treated with high-dose steroids. Two months after discharge, she was no longer on oxygen and was subjectively improved.

DISCUSSION: DILD is a difficult diagnosis given the non-specific symptoms and radiographic findings. Oxaliplatin is becoming an increasingly well-established cause of DILD. One retrospective study identified that 11 of 734 patients on FOLFOX developed DILD and 4 of those patients died.2 There is no clear mechanism of lung injury, though there is data suggesting that oxaliplatin may cause glutathione depletion in the liver. By extension, depletion of glutathione in the lungs may lead to oxidative damage and thus DILD.3

CONCLUSIONS: DILD requires both a high index of clinical suspicion and knowledge of what drugs can cause such toxicities. Making a timely diagnosis is crucial for patients as stopping the offending agent is key. Oxaliplatin in increasingly becoming recogized as an important culprit.

Reference #1: Schwaiblmair M, Behr M, et al. Drug Induced Interstitial Lung Disease. The Open Respiratory Medicine Journal. 2012; 6: 63-74

Reference #2: Shimura T, Fuse N, et al. Clinical features of interstitial lung disease induced by standard chemotherapy (FOLFOX or FOLFIRI) for colorectal cancer. Annals of Oncology. 2010; 21(10): 2005-2010.

Reference #3: Rubbia-Brandt L, Audard V et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Annals of Oncology. 2004; 15(3): 460-466.

DISCLOSURE: The following authors have nothing to disclose: Lydia Winnicka, Crystal Duran, Charumathi Raghu Subramanian

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