Reactions 1282 - 12 Dec 2009

SAntineoplastics

Pancytopenia in an elderly patient: case reportA 66-year-old man developed pancytopenia during

treatment with cyclophosphamide, doxorubicin, vincristineand prednisolone for lymphomatoid granulomatosis.

The man presented with worsening dyspnoea, flu-likesymptoms and difficulty breathing; 4 days earlier, he hadreceived a provisional diagnosis of community-acquiredpneumonia and had started receiving levofloxacin andoxygen. Chest x-ray and CT scan were suggestive ofinterstitial pneumonia and methylprednisolone sodiumsuccinate was added to levofloxacin treatment. However,his respiratory status deteriorated and he was intubatedand mechanically ventilated. Following further pathologicaland immunohistochemical investigations, he wasdiagnosed with lymphomatoid granulomatosis and startedreceiving high-dose steroids and rituximab. He wasextubated 4 days later, after which the treatment wascontinued with cyclophosphamide, vincristine,doxorubicin and prednisolone [dosages not stated]. Heshowed gradual resolution of clinical and x-ray findings.However, after an unspecified duration, he developedpancytopenia related to chemotherapy along with septicshock and acute renal failure.

The man received pressors for septic shock andaggressive management for renal failure. His condition didnot improve and, 4 weeks later, he was terminally weanedas per his family wishes.

A chest-only autopsy showed diffuse alveolar damage,likely secondary to chemotherapy or sepsis or both.Makol A, et al. Lymphomatoid granulomatosis masquerading as interstitialpneumonia in a 66-year-old man: a case report and review of literature. Journal ofHematology & Oncology 2: 160-162, No. 39, Sep 2009 - USA 801154952

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Reactions 12 Dec 2009 No. 12820114-9954/10/1282-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved