title: Severe eosinophilic pneumonia presenting during gemcitabine adjuvant chemotherapy.
abstract: Gemcitabine is widely accepted as the standard treatment for pancreatic cancer, but it can cause unpredictable side effects. Acute respiratory distress syndrome is a rare complication with gemcitabine, but is sometimes fatal. We describe a cured case of acute, severe gemcitabine-induced pulmonary toxicity. The patient was a 76-year-old man with pancreatic cancer who was receiving adjuvant gemcitabine chemotherapy after surgery. The patient received gemcitabine 1,000 mg/m2 on days 1, 8, and 15 for three 4-week cycles, with intervals of 1 week. He developed severe general fatigue on day 1 of the third cycle. Computed tomography showed diffuse ground-glass opacity with pleural effusion. There was no increase in β-D-glucan, and cytomegalovirus antigenemia assays were negative. No bacteria or acid-fast bacilli were found. The number of eosinophils in bronchoalveolar lavage fluid was increased. Considering these data, we diagnosed eosinophilic pneumonia induced by gemcitabine. The patient was immediately treated with a steroid and neutrophil elastase inhibitor under respiratory supportive therapy. After 4 weeks, his pulmonary symptoms were markedly improved. Physicians should be cognizant of the possible association of serious pulmonary toxicity with gemcitabine treatment. A delay in diagnosis and treatment could lead to a fatal outcome.
authors.affiliation: Department of Community Medical Support Institute, Saga University, Saga, Japan. kashiwad@cc.saga-u.ac.jp
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yakabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Kitahara
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Komiya
authors.forename: Naoko
authors.initials: N
authors.lastname: Sueoka-Aragane
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugioka
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Noshiro
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine