title: Interstitial pneumonitis from treatment with gemcitabine.
abstract: BACKGROUND
  The use of gemcitabine may lead to numerous adverse effects ranging from mild to very severe, such as interstitial pneumonitis. The diagnosis of this complication is based on multiple laboratory findings, radiographic evidence, and high clinical suspicion. Presented is a case report of a patient who met these criteria and had onset consistent with drug-induced interstitial pneumonitis.
  
  
  METHODS
  A 76-year-old White female was treated with gemcitabine for pancreatic cancer. Two months after the initiation of therapy, she was admitted to the hospital for worsening dyspnea and cough. High clinical suspicion, bilateral interstitial opacities on chest x-ray, worsening pulmonary status, and onset 2 months after initiation of therapy led to the diagnosis of gemcitabine-induced interstitial pneumonitis. Steroid therapy with prednisone was initiated, and the patient's clinical symptoms and radiographic findings improved.
  
  
  CONCLUSIONS
  Gemcitabine-induced interstitial pneumonitis is well described in the literature. It is a rare but serious complication associated with gemcitabine therapy in which patients present with worsening dyspnea. Most patients only require supportive care and discontinuation of the drug for treatment, but in severe cases supplemental oxygen and steroid therapy must be used before resolution of symptoms. It is important to obtain an accurate medication history to evaluate for other potentially pulmonary toxic medications. Radiographic findings such as bilateral infiltrates should be completely resolved after therapy.
  
  
  CONCLUSIONS
  Radiographic findings, clinical symptoms, and clinical suspicion can lead to early recognition of interstitial pneumonitis from gemcitabine. Physician awareness of this adverse effect and early recognition are keys to providing prompt treatment in resolving symptoms and decreasing mortality.
authors.affiliation: PGY1 Pharmacy Resident, Department of Pharmacy, University of Tennessee Medical Center , Knoxville, Tennessee.
authors.forename: Brolin B
authors.initials: BB
authors.lastname: Poole
authors.affiliation: Assistant Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy , Knoxville, Tennessee.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hamilton
authors.affiliation: Clinical Pharmacist, Department of Pharmacy, University of Tennessee Medical Center , Knoxville, Tennessee.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Brockman
authors.affiliation: Professor and Associate Dean, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy , Knoxville, Tennessee.
authors.forename: Debbie C
authors.initials: DC
authors.lastname: Byrd
keywords: gemcitabine; pneumonitis; pulmonary toxicity