title: Fatal pneumonia associated with temozolomide therapy in patients with malignant glioma.
abstract: This report presents the cases of three patients with fatal pneumonia that was highly suspected to be Pneumocystis pneumonia (PCP) based on serological diagnosis. Their chest radiographs showed bilateral pneumonia and each had presented with severe respiratory failure requiring mechanical ventilation when they arrived at the hospital. Although bronchoscopical sampling could not be performed, their chest computed tomography imaging and a marked elevation of serum KL-6 and β-D-glucan levels were characteristic of Pneumocystis pneumonia. All three were found to have been treated with temozolomide after surgery for malignant glioma. Temozolomide can cause Pneumocystis pneumonia. The three patients did not receive prophylactic medication against Pneumocystis pneumonia during treatment with temozolomide, and their histories suggested that all had delayed seeking treatment. It may be difficult to diagnose Pneumocystis pneumonia because the symptoms are not specific for Pneumocystis pneumonia and they tend to be similar to those of common respiratory infectious diseases. Therefore, patients who receive temozolomide therapy have the potential to develop fatal pneumonia and should be carefully observed. The patients should also be adequately informed about Pneumocystis pneumonia, and prophylaxis against Pneumocystis pneumonia should be considered proactively before treatment with temozolomide is initiated.
authors.affiliation: Division of Pulmonary Medicine, Infectious Diseases, and Oncology, Department of Internal Medicine, Nippon Medical School, and Department of Internal Medicine, Heisei Tateisi Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Saito
authors.forename: Nariaki
authors.initials: N
authors.lastname: Kokuho
authors.forename: Taisuke
authors.initials: T
authors.lastname: Morimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Abe
authors.forename: Kazue
authors.initials: K
authors.lastname: Fujita
authors.forename: Arata
authors.initials: A
authors.lastname: Azuma
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004348:Drug Labeling; D017809:Fatal Outcome; D005260:Female; D005910:Glioma / Q000188:drug therapy*; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D007564:Japan; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011014:Pneumonia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D011030:Pneumothorax / Q000209:etiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D011859:Radiography; D013211:Staphylococcus aureus / Q000302:isolation & purification; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide