¹³¹I-labeled lipiodol-induced interstitial pneumonia: a series of 15 cases.
BACKGROUND
The drug (131)I-labeled lipiodol is used as internal radiotherapy for unresectable hepatocellular carcinoma. Although the drug was considered safe during preapproval studies, we observed several cases of interstitial pneumonia following its administration.


METHODS
Cases were retrospectively identified through the drug safety unit database of Rennes University Hospital.


RESULTS
From 1994 to 2009, interstitial pneumonia developed in 15 patients following (131)I-labeled lipiodol administration, with an estimated prevalence of 15.5 cases (95% CI, 7.7-23.2) per 1,000 treated patients. Mean age of the patients was 60 ± 8 years, and the male to female ratio was 6.5:1. All patients had cirrhosis, mainly related to long-term alcohol intoxication (n = 12). Most (n = 10) cases occurred after the second (131)I-labeled lipiodol injection. The median delay between last (131)I-labeled lipiodol administration and first respiratory symptoms was 30 days (interquartile range, 16.5-45 days). All patients presented with shortness of breath. Physical examination mostly revealed fever (n = 11) and bilateral crackles (n = 12). Chest CT scan showed bilateral ground-glass opacities (n = 8) with septal thickening, retraction, or both (n = 8). BAL (n = 7) was remarkable for increased neutrophils (n = 4) or CD8(+) T cell count (n = 3). Despite corticosteroids, 12 (80%) patients died, mostly of untractable respiratory failure (n = 9). Median delay between last (131)I-labeled lipiodol injection and death was 63 days (interquartile range, 34-129 days).


CONCLUSIONS
Interstitial pneumonia may be a serious and not uncommon complication of (131)I-labeled lipiodol administration.
Respiratory Diseases Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France. Electronic address: Stephane.jouneau@chu-rennes.fr.
Stéphane
S
Jouneau
Medical Oncology Department, Centre Eugène Marquis, European University in Brittany, Rennes, France.
Elodie
E
Vauléon
Histopathology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Sylvie
S
Caulet-Maugendre
Clinical Pharmacology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Elisabeth
E
Polard
Intensive Care Department, Pau Hospital, Pau, France.
Anne-Claire
AC
Volatron
Pharmacovigilance, Radiology Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Catherine
C
Meunier
Infectious Diseases and Intensive Care Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Pierre
P
Tattevin
Respiratory Diseases Department, INSERM U999, Paris-Sud 11 University, Centre National de Référence de l'Hypertension Pulmonaire Sévère, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France.
David
D
Montani
Nuclear Medicine Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Etienne
E
Garin
Medical Oncology Department, Centre Eugène Marquis, European University in Brittany, Rennes, France.
Jean-Luc
JL
Raoul
Respiratory Diseases Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France.
Philippe
P
Delaval
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D004998:Ethiodized Oil / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D004998:Ethiodized Oil