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• W4387248972 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Gemcitabine is a pyrimidine analog used as chemotherapy in the treatment of a wide range of both solid and liquid malignancies. As is the case with most chemotherapy, Gemcitabine maintains a wide range of known adverse reactions. Its most notable effect is on the lungs with complications ranging from interstitial pneumonitis, eosinophilic pneumonia, and even acute respiratory distress syndrome and diffuse alveolar hemorrhage. The majority of these pulmonary complications arise after the second cycle and often respond to steroids, which are given empirically prior to bronchoscopy to rule out infectious etiologies including Pneumocystis Jirovecii pneumonia (PJP). CASE PRESENTATION: We present a 79-year-old male with a past medical history of HTLV-1 Adult T-Cell Lymphoma who underwent targeted radiation therapy to cutaneous lesions as well as multiple lines of chemotherapy over the course of 11 years. Most recently, he completed 15 sessions of Gemcitabine and Doxorubicin, which had initially been well tolerated. Soon after his regularly scheduled infusion, he developed dyspnea on exertion that continued to progress warranting him to seek medical care. He was found to be in hypoxic respiratory failure as well as febrile. His initial workup with computed tomography of the chest demonstrated bilateral upper lobe predominant interstitial infiltrates, associated with ground glass opacities and thickened interlobular septae in a symmetrical pattern, consistent with pneumonitis. After being started on empiric broad-spectrum antibiotics, a peripheral workup showed negative fungal markers, respiratory viral panel, and atypical pathogen studies. He later underwent bronchoscopy to further identify the etiology of his respiratory failure and pulmonary changes, which demonstrated no bacterial or fungal growth, as well as a negative mycobacterium and PJP PCR. Bronchoalveolar lavage with flow cytometry and transbronchial biopsy did not show any evidence of malignancy involvement. He continued to improve clinically with antibiotics alone but was then started on steroids for pneumonitis as other etiologies were ruled out with further improvement. DISCUSSION: Although it is recommended to commence steroid therapy empirically when suspecting Gemcitabine-induced pneumonitis, certain challenges may arise that could delay care. In this case, our patient had undergone many more cycles of Gemcitabine than is usually required to induce pneumonitis reactions. This, coupled with fevers making infectious causes of greater concern, it was decided to rule out other reversible causes before initiating empiric therapy that would be detrimental if an infection was present. CONCLUSIONS: This patient suffered no negative consequences of undergoing bronchoscopy with BAL prior to steroid therapy. We propose a more targeted approach to diagnosis followed by treatment when suspecting Gemcitabine-induced pneumonitis. REFERENCE #1: Thalambedu N, El-Habr AH. Gemcitabine induced pneumonitis: a case report and review of literature. J Community Hosp Intern Med Perspect. 2020 Oct 29;10(6):579-582. doi: 10.1080/20009666.2020.1811071. PMID: 33194133; PMCID: PMC7598946. REFERENCE #2: Turco C, Jary M, Kim S, Moltenis M, Degano B, Manzoni P, Nguyen T, Genet B, Rabier MB, Heyd B, Borg C. Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease. Clin Med Insights Oncol. 2015 Sep 1;9:75-9. doi: 10.4137/CMO.S26537. PMID: 26380562; PMCID: PMC4559186. DISCLOSURES: No relevant relationships by Michael Liben No relevant relationships by Amanda Warren" @default.
• W4387248972 created "2023-10-03" @default.
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• W4387248972 date "2023-10-01" @default.
• W4387248972 modified "2023-10-03" @default.
• W4387248972 title "DELAYED STEROID THERAPY IN GEMCITABINE-INDUCED PNEUMONITIS" @default.
• W4387248972 doi "https://doi.org/10.1016/j.chest.2023.07.2179" @default.
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