title: 'Flooding' of the lungs and severe dyspnea in a patient with bronchoalveolar carcinoma.
abstract: In this case report, we describe a patient with bronchoalveolar carcinoma that experienced severe bronchorrhea and dyspnea after inhalation of N-acetylcysteine. The adverse reactions occurred both after oral and nebulized administration of N-acetylcysteine, resulting in severe dyspnea and the feeling of 'drowning'. Bronchorrhea has previously been reported as an uncommon but serious complication of bronchoalveolar carcinoma. We strongly suspect the administration of N-acetylcysteine to be implicated, as the complications occurred immediately after administration of this drug. As the patient suffered from hyperhomocysteinemia, we speculate that an additive or synergistic interaction with homocysteine may have been involved as well.
authors.affiliation: Department of Pharmacy & Pharmacology, Slotervaart Hospital/The Netherlands Cancer Institute, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. ron.keizer@slz.nl
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Keizer
authors.forename: Jos H
authors.initials: JH
authors.lastname: Beijnen
authors.forename: Paul
authors.initials: P
authors.lastname: Baas
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000009:adverse effects*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000150:complications*; D000280:Administration, Inhalation; D000284:Administration, Oral; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005100:Expectorants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications; D008168:Lung / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000150:complications*; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012307:Risk Factors; D012720:Severity of Illness Index; D013183:Sputum / Q000378:metabolism*
chemical_list: D005100:Expectorants; D000111:Acetylcysteine