title: Fatal bilateral pneumonitis after locoregional thoracic chemoradiation in a transplanted patient under immunosuppressive therapy.
abstract: BACKGROUND
  After thoracic radiotherapy a pneumonitis may occur, mostly confined to the irradiated volume of the lung. In general, it resolves spontaneously without long-term effects.
  
  
  METHODS
  A 68-year-old man was diagnosed with a stage IIIA adenocarcinoma of the lung and was treated with sequential chemoradiation. He had a heart and kidney transplant for which an immunosuppressant was taken. During the fourth week of radiotherapy, he developed a bilateral interstitial pneumonia. Despite antibiotics and steroids, the patient died twelve days after the onset of complaints due to respiratory failure. Autopsy showed in all pulmonary lobes extensive diffuse alveolar damage, probably leading to respiratory insufficiency and death. Literature and Conclusion: Bilateral pneumonitis after radiotherapy is thought to be an immunologically-mediated response, which usually resolves without long-term effects. Since in radiation pneumonitis an increase in T-cells is described, the suppression of these cells by an immunosuppressant might have exaggerated the pulmonary toxicity.
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands p.g.westhoff@umcutrecht.nl.
authors.forename: Paulien G
authors.initials: PG
authors.lastname: Westhoff
authors.affiliation: Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium.
authors.forename: Dirk K M
authors.initials: DK
authors.lastname: De Ruysscher
authors.affiliation: Department of Pulmonary Diseases, Saint Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Franz M N H
authors.initials: FM
authors.lastname: Schramel
authors.affiliation: Department of Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Metin
authors.initials: M
authors.lastname: Bulbul
authors.affiliation: Department of Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Amelie
authors.initials: A
authors.lastname: Dendooven
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Sherif Y
authors.initials: SY
authors.lastname: El Sharouni
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects*; D017809:Fatal Outcome; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D017564:Radiation Pneumonitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Thoracic radiotherapy; chemoradiation; immunosuppressant; radiation pneumonitis; sporadic pneumonitis