title: [The value of transbronchial lung biopsy findings in the diagnosis of a case of TS-1-induced pulmonary toxicity].
abstract: We report the case of a 67-year-old man with a diagnosis of stage IV stomach cancer in May 2010 who was treated with outpatient chemotherapy using TS-1, paclitaxel and lentinan. Dyspnea and coughing developed after drug administration in November and the patient was hospitalized on day 5 after the appearance of symptoms due to hypoxemia and the presence of ground-glass opacities in the right middle and lower lung fields. On the same day, bronchoscopy was performed for differentiation from infection and lymphangitic carcinomatosis. A transbronchial lung biopsy suggested drug-induced pulmonary toxicity, and a drug lymphocyte stimulation test was highly positive for TS-1. Discontinuation of TS-1 alone improved his respiratory status and imaging findings. TS-1 is available only in Japan, and because it is administered orally and its toxicity is minimal, its use has been expanded to treat a variety of malignancies. Drug-induced pulmonary toxicity due to TS-1 occurs in only 0.03% of all cases, and there are few reports regarding the histopathological findings of TS-1-related pulmonary toxicity. Although it can be difficult to diagnose drug-induced pulmonary toxicity because it demonstrates a variety of imaging findings, the present case suggests that it is important to proactively perform transbronchial lung biopsy at the early stage of diagnosis and promptly determine a course of treatment.
authors.affiliation: Department of Internal Medicine, Nippon Medical School, Musashikosugi Hospital.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ito
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Morisue
authors.forename: Yukari
authors.initials: Y
authors.lastname: Ogaw
authors.forename: Kazuo
authors.initials: K
authors.lastname: Munakata
authors.forename: Yuh
authors.initials: Y
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001706:Biopsy; D004338:Drug Combinations; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D010094:Oxonic Acid / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000188:drug therapy; D005641:Tegafur / Q000009:adverse effects*
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid