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

Taxanes and Sjögrens Syndrome - A Fatal Combination: A Case Report FREE TO VIEW

Rami Zein, DO; Jason Mouabbi, MD; Mohamed Rezik, DO; Tarik Hadid, MD
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St. John Hospital and Medical Center, Dearborn, MI

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

Chest. 2016;150(4_S):527A. doi:10.1016/j.chest.2016.08.541
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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: The taxanes, paclitaxel and docetaxel, are known to cause pulmonary injury. The most common pulmonary toxicity, interstitial pneumonitis, can develop within days to weeks after receiving the drug. Herein, we present a case of a Sjögrens syndrome patient with docetaxel induced ARDS.

CASE PRESENTATION: A 68-year-old Caucasian female with a history of recurrent breast cancer and Sjögrens syndrome presented with worsening dyspnea. She was recently started back on her taxane chemotherapy. Following 4 weeks of treatment the patient developed dyspnea and was subsequently admitted to the hospital. CT of the chest demonstrated interstitial disease, with patchy ground glass opacities, possibly on an inflammatory basis. She discontinued her docetaxel and was treated with diuretics and IV steroids for concern of drug-related pneumonitis. She discharged following 2 days of treatment and improvement of her symptoms. Approximately 1 month later, she presented with worsening dyspnea. A CTA exhibited increasing interstitial changes noted within both upper lobes, as well as within the right middle lobe and within portions of the lower lobes compared to her previous CT. She also displayed prominent underlying chronic interstitial pulmonary fibrosis secondary to her Sjögrens. Bronchoscopy was non-diagnostic. Cultures were negative, however, she was still covered with broad spectrum antibiotics. Over the course of 6 days, the patient’s oxygen requirement increased and she was subsequently intubated due to her hypoxia. The patient developed severe ARDS and the patient’s family made her a DNR/DNI. The patient expired secondary to severe hypoxia.

DISCUSSION: Taxanes, specifically docetaxel, have been associated with acute permeability edema, adult respiratory distress syndrome, and pleural effusions due to capillary leakage secondary to immune-mediated delayed hypersensitivity reaction. In a case review, 39% of docetaxel induced pneumonitis patients died from ARDS. Early termination of docetaxel use and treatment with diuretics and steroids have been shown to decrease the progression of severe fluid retention and progression to ARDS.

CONCLUSIONS: Patients treated with taxane chemotherapy with underlying interstitial lung disease are at high risk of developing fatal pneumonitis. Sjögrens patients who are on taxane chemotherapy must be monitored closely for development of ARDS.

Reference #1: Wang GS, Yang KY, Perng RP. Life-threatening hypersensitivity pneumonitis induced by docetaxel (taxotere). Br J Cancer 2001; 85:1247.

Reference #2: Ochoa R, Bejarano PA, Glück S, Montero AJ. Pneumonitis and pulmonary fibrosis in a patient receiving adjuvant docetaxel and cyclophosphamide for stage 3 breast cancer: a case report and literature review. J Med Case Rep 2012; 6:413.

Reference #3: Fujimori K, Yokoyama A, Kurita Y, et al. Paclitaxel-induced cell-mediated hypersensitivity pneumonitis. Diagnosis using leukocyte migration test, bronchoalveolar lavage and transbronchial lung biopsy. Oncology 1998; 55:340.

DISCLOSURE: The following authors have nothing to disclose: Rami Zein, Jason Mouabbi, Mohamed Rezik, Tarik Hadid

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