title: High-resolution computed tomography findings for patients with drug-induced pulmonary toxicity, with special reference to hypersensitivity pneumonitis-like patterns in gemcitabine-induced cases.
abstract: BACKGROUND
  Gemcitabine (GEM) is widely used as a chemotherapeutic agent. However, pulmonary toxicity has been rarely observed with GEM use. This article aims to determine the incidence and causes of drug-induced pulmonary toxicity, and to classify the high-resolution computed tomography (HRCT) findings for antitumor therapy-associated pulmonary toxicity based on characteristic patterns and pathological considerations, with a special focus on GEM-associated pulmonary toxicity (GAPT).
  
  
  METHODS
  Medical records of all patients with drug-induced pulmonary toxicity seen at Kyorin University hospital between April 2006 and December 2011 were retrospectively reviewed. The study examined correlations between HRCT and the assessed pathological or clinical findings, with a specific focus on antitumor drugs.
  
  
  RESULTS
  We identified 66 patients with drug-induced pulmonary toxicity. Among the antitumor drugs, GEM was the primary offending agent (n = 8) for pulmonary toxicity followed by docetaxel and gefitinib. HRCT patterns for the eight GAPT patients included the non-specific interstitial pneumonia (NSIP; n = 5) and the hypersensitivity pneumonitis (HP)-like pattern (n = 3). In contrast, four patients in the study were found to have the HP-like pattern, with three cases associated with GEM and one case associated with imatinib mesylate. The transbronchial lung biopsy or video-assisted thoracic surgery specimens for these patients showed granuloma or organizing tissue with a random distribution that was independent of the respiratory bronchiole. These results appeared to correspond to the HRCT-determined centrilobular nodules.
  
  
  CONCLUSIONS
  GEM was the leading cause of drug-induced pulmonary toxicity in the patients examined in this study. This toxicity appears as NSIP or an HP-like pattern during HRCT examinations. This HP-like pattern may be useful for diagnosing GEM-induced pulmonary toxicity, as well as demonstrating granuloma or organizing tissue during lung pathology examinations.
authors: Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Masaki
authors: M
authors: Tamura
authors: Takeshi
authors: T
authors: Saraya
authors: Masachika
authors: M
authors: Fujiwara
authors: Sayuki
authors: S
authors: Hiraoka
authors: Takuma
authors: T
authors: Yokoyama
authors: Kinuko
authors: K
authors: Yano
authors: Haruyuki
authors: H
authors: Ishii
authors: Junji
authors: J
authors: Furuse
authors: Tomoyuki
authors: T
authors: Goya
authors: Hajime
authors: H
authors: Takizawa
authors: Hajime
authors: H
authors: Goto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001706:Biopsy; D000077143:Docetaxel; D005260:Female; D000077156:Gefitinib; D006099:Granuloma / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D043823:Taxoids; D000077143:Docetaxel; D000077156:Gefitinib
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