title: Gemcitabine-induced pulmonary toxicity during adjuvant therapy in a patient with pancreatic cancer.
abstract: BACKGROUND
  Gemcitabine is a pyrimidine antimetabolite with activity in a number of cancers. Gemcitabine is the accepted standard for the adjuvant and metastatic treatment of pancreatic cancer, however, it also has indications in breast, ovarian, and non-small cell lung cancers. The most common side effect is myelosuppression. Dyspnea is reported in 23% and bronchospasm occurs in less than 2% of subjects. Acute respiratory distress syndrome is rare with single agent use or in combination.
  
  
  METHODS
  A 68-year-old man being treated for stage IIA pancreatic cancer after pancreaticoduodenectomy developed hypoxemic respiratory distress after the second dose of gemcitabine 1,000 mg/m(2). The radiographic findings on computed tomography scans evolved from ground glass opacities to findings suggestive of cryptogenic organizing pneumonia over the course of two weeks. He was treated with antibiotics, steroids, nebulizers and oxygen. A follow-up computed tomography scan of chest four weeks after presentation showed complete resolution of pneumonitis.
  
  
  CONCLUSIONS
  We report the first case of gemcitabine-induced pneumonitis encountered during the adjuvant treatment of pancreatic cancer. Physicians seeing such patients should be aware of this rare but real pulmonary toxicity. A delay in diagnosis and treatment can lead to potentially fatal outcomes.
authors.affiliation: Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT 06521, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Shaib
authors.forename: Frederick
authors.initials: F
authors.lastname: Lansigan
authors.forename: Daniel
authors.initials: D
authors.lastname: Cornfeld
authors.forename: Kostas
authors.initials: K
authors.lastname: Syrigos
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Saif
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects*; D008297:Male; D010102:Oxygen Inhalation Therapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D011014:Pneumonia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil; D000093542:Gemcitabine