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• W4387248277 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 5 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) occurs secondary to exposures to medications, toxins, or infections (1). Tyrosine kinase inhibitors (TKI), such as Osimertinib, is used in the treatment of non-small cell lung cancer. Lung injuries such as interstitial lung disease and pneumonitis have been associated with TKI (2). However, TKI-induced AEP has been rarely reported in literature (3). We describe a case of AEP secondary to Osimertinib therapy. CASE PRESENTATION: A 67-year-old female with medical history of adenocarcinoma of the lung status post right lower lobe lobectomy presented to the hospital with a three week history of worsening dyspnea. She had been on Osimertinib as an outpatient for two years. Her symptoms were associated with mild pleuritic chest pain and persistent dry cough. Initial vitals were T 101.3 F, HR 79 bpm, RR 18, BP 128/72 mmhg and saturating 92% on 10 liters of oxygen. Laboratory workup revealed white blood cell count of 11,300/µL with neutrophilic predominance, D-dimer 460 ng/ml, and sedimentation rate > 130 mm. Respiratory viral panel was negative. CT pulmonary angiogram revealed multifocal ground glass opacities (GGO), more prominent in the right upper lobe and no pulmonary embolism (Figure 1 and 2). The patient was admitted for acute hypoxic respiratory failure and empirically initiated on Ceftriaxone and Azithromycin. Bronchoscopy with bronchoalveolar lavage (BAL) was performed given worsening respiratory status which revealed a differential cell count of 29% eosinophils, negative pneumocystis smear, negative fungitell and unremarkable respiratory and fungal cultures. Given concern for medication-induced AEP, Osimertinib was held and the patient was started on corticosteroids with rapid clinical and radiographic improvement. DISCUSSION: We describe a case of AEP as rare pulmonary complication secondary to Osimertinib. Interstitial lung disease, pneumonitis and dermatological toxicities are commonly reported adverse events (3). To our knowledge, there are only 3 other case reports that detail Osimertinib-induced AEP, with symptoms developing within 9 months of drug use (3). Chest CT findings typically show bilateral GGO with upper lobe predominance (1). Diagnosis depends on BAL fluid demonstrating eosinophil fraction > 25% and the exclusion of other disease processes (1). Peripheral blood eosinophilia may be absent or delayed. Management includes elimination of underlying cause and low doses of corticosteroids. CONCLUSIONS: Our patient developed late-onset AEP as a rare complication from TKI therapy. Prompt improvement with cessation of Osimertinib and initiation of corticosteroids was noted. Characteristic CT chest and BAL findings can help confirm diagnosis, thus emphasizing the importance of early bronchoscopy to establish a diagnosis. If there is a high level of suspicion for AEP, it is important for clinicians to promptly stop the offending agent and treat with early corticosteroid therapy. REFERENCE #1: De Giacomi, F., Vassallo, R., Yi, E. S., & Ryu, J. H. (2018). Acute eosinophilic pneumonia. causes, diagnosis, and management. American Journal of Respiratory and Critical Care Medicine, 197(6), 728–736. https://doi.org/10.1164/rccm.201710-1967ci REFERENCE #2: Ohmori, T., Yamaoka, T., Ando, K., Kusumoto, S., Kishino, Y., Manabe, R., & Sagara, H. (2021). Molecular and clinical features of EGFR-TKI-associated lung injury. International Journal of Molecular Sciences, 22(2), 792. https://doi.org/10.3390/ijms22020792 REFERENCE #3: Patel, K. G., Corbett, R. L., Karanjawala, Z. E., Kelly, K. A., Stollenwerk, N., & Riess, J. W. (2022). A case of osimertinib-induced eosinophilic pneumonia. Clinical Lung Cancer, 23(7), 639–642. https://doi.org/10.1016/j.cllc.2022.07.013 DISCLOSURES: No relevant relationships by Joseph Bahgat No relevant relationships by Debapriya Datta No relevant relationships by Fatima Ghazal No relevant relationships by Resham Pawar No relevant relationships by Mario Perez No relevant relationships by Siddharth Venkat Ramanan" @default.
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• W4387248277 date "2023-10-01" @default.
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• W4387248277 title "TYROSINE KINASE INHIBITOR-INDUCED ACUTE EOSINOPHILIC PNEUMONIA" @default.
• W4387248277 doi "https://doi.org/10.1016/j.chest.2023.07.2196" @default.
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