title: Hypersensitivity pneumonitis-like syndrome associated with the use of lenalidomide.
abstract: Lenalidomide is an immunomodulatory agent approved for use in patients with myelodysplastic syndrome, and in combination with dexamethasone for refractory or relapsed multiple myeloma. Pulmonary toxicity is believed to be uncommon. In this report, we describe a patient receiving lenalidomide in whom dyspnea, fever, hypoxia, and diffuse pulmonary infiltrates developed. BAL demonstrated a significant lymphocytic alveolitis typical for hypersensitivity pneumonitis. Extensive workup for other causes, including infections, was negative. Finally, the patient had improvement in symptoms and oxygenation after withdrawing lenalidomide and recurrence of symptoms when the drug was restarted. Thus, the patient's clinical course and workup strongly support a diagnosis of lenalidomide-induced hypersensitivity pneumonitis-like syndrome. Physicians should be cognizant of this potential complication in patients receiving thalidomide or thalidomide-like drugs who present with fever and pulmonary infiltrates and fail to improve despite treatment with broad-spectrum antibiotics.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University Medical Center, 1481 W Tenth Street, VA 111P-IU, Indianapolis, IN 46202, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Thornburg
authors.forename: Rafat
authors.initials: R
authors.lastname: Abonour
authors.forename: Patricia
authors.initials: P
authors.lastname: Smith
authors.forename: Kenneth
authors.initials: K
authors.lastname: Knox
authors.forename: Homer L
authors.initials: HL
authors.lastname: Twigg
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D000077269:Lenalidomide; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D013577:Syndrome; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide