Lung Pathology: Fellow Case Report Poster - Lung Pathology |

Ibrutinib-Induced Organizing Pneumonia FREE TO VIEW

Lauren Blackwell, MD; Donghong Cai, MD; Shanti Srinivas, MD; Constantinos Lovoulos, MD; Jenny Kim, MD
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Rutgers, New Jersey Medical School, Bloomfield, NJ

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

Chest. 2016;150(4_S):782A. doi:10.1016/j.chest.2016.08.878
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Ibrutinib is an oral Bruton tyrosine kinase (BTK) inhibitor used in the treatment of B-cell lymphomas, including relapsed or refractory chronic lymphocytic leukemia. We report a case of a patient who developed organizing pneumonia after treatment with Ibrutinib.

CASE PRESENTATION: The patient is a 67 year old man with history of hypothyroidism and low grade B cell lymphoma initially treated with Bendamustine and Rituximab who presented with recurrence. He began treatment with Ibrutinib and developed bilateral lung infiltrates with a large nodular opacity in the right upper lobe (RUL) on re-staging CT chest. He experienced dyspnea on exertion, non-productive cough, and 30 lbs unintentional weight loss. The RUL nodule grew rapidly over a six-month period and measured 3.6 cm x 2.6 cm. It had an uptake of 11.2 SUV on PET/CT. BAL cultures grew E. coli, K. pneumonia, and MRSA. Cytology and transbronchial biopsy were negative for malignant cells. A prolonged course of antibiotics did not result in symptom resolution. A wedge resection of the RUL mass was performed. Histopathology was negative for malignancy and infection. However, areas of organizing pneumonia and fibrosis were noted. A course of oral corticosteroids resulted in symptomatic improvement and radiologic improvement in the appearance of the RUL mass.

DISCUSSION: Ibrutinib commonly causes hematologic adverse events. Pneumonia and upper respiratory infections have also been reported, but are less common1. There are two case reports describing pneumonitis that developed in patients being treated for relapsed/refractory CLL with Ibrutinib2,3.

CONCLUSIONS: Ibrutinib was approved to treat CLL in February 2014. Organizing pneumonia is a previously unreported adverse effect resulting from Ibrutinab treatment.

Reference #1: Tobinai et al. Safety and tolerability of ibrutinib monotherapy in Japanese patients with relapsed/refractory B cell malignancies. Int J Hematol. 2016 Jan;103(1):86-94.

Reference #2: Mato et al. Ibrutinib-induced pneumonitis in patients with chronic lymphocytic leukemia. Blood. 2016 Feb 25;127(8):1064-7.

Reference #3: Progressive inflammatory pneumonitis and hypoxic respiratory failure: case report. Reactions Weekly. 2015 Nov; 1578 (1): 159.

DISCLOSURE: The following authors have nothing to disclose: Lauren Blackwell, Donghong Cai, Shanti Srinivas, Constantinos Lovoulos, Jenny Kim

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