title: Acute pneumonitis consequent on pleurodesis with Viscum album extract: severe chest images but benign clinical course.
abstract: Chemical pleurodesis is widely recommended in the treatment of pulmonary air leak of different etiologies as well as malignant pleural effusions and chylothorax. Conventional chemical pleurodesis using erythromycin, tetracycline, hydrophilic fumed silica, autologous blood and talc slurry has been standardized, and its complications, including high fever, intractable chest pain, and acute lung injury, seem to be frequent. Viscum album extract is a new chemical agent for pleurodesis, and only a few studies have reported outcomes of such chemical pleurodesis in the treatment of malignant pleural effusion. Moreover, the complications resulting from pleurodesis using Viscum album extract are very rare, and acute pneumonitis has not been reported. in this paper we report the first case of acute pneumonitis after pleurodesis using Viscum album extract in a 58-year-old man who had prolonged air leaks after a left upper lingularsegmentectomy for metastatic lung cancer. We performed repeated pleurodesis four times with 2 to 4 days intervals. While the patient had no symptoms of pneumonia, such as cough, sputum, chilling, and fatigue, a follow-up chest X-ray revealed increasing peribronchial consolidations and infiltrations in the left upper lobe. A chest tomography showed extensive parenchymal consolidations and ground-glass appearances in the left lungs, representing pneumonia with acute lung injury. The acute pneumonitis was spontaneously resolved with supportive care, and the patient was discharged ten days after the development of pneumonitis. We think that pleurodesis with Viscum album extract is effective, but repeated pleurodesis should be avoided for possible onset of acute pneumonitis.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Suk Ju
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju Special Self-Governing Province 690-767 Korea.
authors.forename: Su Wan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju Special Self-Governing Province 690-767 Korea.
authors.forename: Jee Won
authors.initials: JW
authors.lastname: Chang
keywords: Computed tomography; Lung infection; Pneumothorax; Segmentectomy