title: Corticosteroid-responsive pulmonary toxicity associated with fludarabine monophosphate: a case report.
abstract: Fludarabine monophosphate is an effective drug for the treatment of lymphoid malignancies. Myelosuppression, opportunistic infections, and autoimmune hemolytic anemia are the most common side effects of fludarabine. Herein we report a 55-year-old female that presented with fever and dyspnea after completing her third cycle of FMD (fludarabine, mitoxantrone, and dexamethasone) chemotherapy for stage IV non-Hodgkin follicular lymphoma. Chest X-ray revealed bilateral pneumofibrotic changes and chest CT showed bilateral diffuse interstitial changes with fibrotic alterations. No evidence of infectious agents was noted. The patient had a reduced carbon monoxide transfer factor (45%). Her symptoms and radiographic findings resolved following treatment with prednisolone. The literature contains several cases of fludarabine-associated interstitial pulmonary toxicity that responded to steroid therapy. Fludarabine-induced pulmonary toxicity is reversible with cessation of the drug and administration of glucocorticosteroids.
  
  
  BACKGROUND
  None declared.
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Milda
authors.initials: M
authors.lastname: Rudzianskiene
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Rasa
authors.initials: R
authors.lastname: Griniute
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Elona
authors.initials: E
authors.lastname: Juozaityte
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Arturas
authors.initials: A
authors.lastname: Inciura
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Viktoras
authors.initials: V
authors.lastname: Rudzianskas
authors.affiliation: Lithuanian University of Health Sciences Hospital, Kauno Klinikos, Oncology and Hematology Department, Kaunas, Lithuania.
authors.forename: Greta
authors.initials: G
authors.lastname: Emilia Kiavialaitis
keywords: Fludarabine monophosphate; Pulmonary toxicity; non-Hodgkin lymphoma