Reactions 1368 - 10 Sep 2011

SAntineoplastics

Pulmonary necrosis: case reportA 48-year-old woman with a relapse of lymphoma

developed pulmonary necrosis after R-CHOPchemotherapy, given through an incorrectly placedimplantable catheter.

The woman relapsed in October 2008, and wasscheduled to receive 6 cycles of R-CHOP (rituximab375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin50 mg/m2 and vincristine 1.4 mg/m2 on day 1, withprednisolone 100 mg/m2 days 1–5) through an implantedcentral venous port. On day 8 of the third cycle, shepresented with lower right chest pain and cough.Investigations revealed pancytopenia, an inflammatorysyndrome, and right-sided pleural effusion. The end of thecatheter projected opposite the pulmonary hilum. CTconfirmed that the catheter tip was in a small branch of theright inferior pulmonary artery; it was surrounded with apocket of lower- and middle-lobe pneumopathy.

The implantable port was removed and the womanreceived antibiotics. Culture of the catheter grew E. coli.She improved, but her pneumopathy persisted; furtherantibiotics and expectorants were given, andchemotherapy was postponed. On day 15, CT showed alung abscess; PET demonstrated necrosis. She underwentsurgery and was discharged after a 13-day hospitalisation;4 months later she had no symptoms.Vanelslander P, et al. Iatrogenic pulmonary necrosis due to hyperselectivechemotherapy. Revue des Maladies Respiratoires 28: 66-70, No. 1, Jan 2011[French; summarised from a translation] - France 803059673

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Reactions 10 Sep 2011 No. 13680114-9954/10/1368-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved