Temozolomide-Associated Bronchiolitis Obliterans Organizing Pneumonia Successfully Treated with High-Dose Corticosteroid

Temozolomide is an oral alkylating agent with clinical activity against glioblastoma multiforme (GM). It is generally well-tolerated and has few pulmonary side effects. We report a case of temozolomide-associated brochiolitis obliterans organizing pneumonia (BOOP) requiring very high-dose corticosteroid treatment. A 56-yr-old woman presented with a 2-week history of exertional dyspnea. For the treatment of GM diagnosed 4 months previously, she had undergone surgery followed by chemoradiotherapy, and then planned adjuvant chemotherapy with temozolomide. After the 1st cycle, progressive dyspnea was gradually developed. Chest radiograph showed diffuse patchy peribronchovascular ground-glass opacities in both lungs. Conventional dose of methylprednisolone (1 mg/kg/day) was begun for the possibility of BOOP. Although transbronchial lung biopsy findings were compatible with BOOP, the patient's clinical course was more aggravated until hospital day 5. After the dose of methylprednisolone was increased (500 mg/day for 5 days) radiologic findings were improved dramatically.

Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Interstitial lung disease (ILD) is one of the common extra-articular manifestations of rheumatoid arthritis (RA). Bronchiolitis obliterans with organizing pneumonia (BOOP) is one type of ILD, and this is characterized by the proliferation of granulation tissue in the bronchioles, alveolar ducts and some alveoli and interstitial infiltration by chronic inflammatory cells. It develops as a manifestation of RA or as a side effect of anti-rheumatic drugs in patients with RA. We experienced a 41-year-old female patient with RA who developed BOOP during the treatment with methotrexate and bucillamine. She presented with cough and sputum for several months and pleuritic chest pain for one week. The chest radiograph showed bilateral multifocal consolidations. She received thoracoscopic biopsy and her pulmonary infiltrations resolved after the treatment with corticosteroid.

A case of bronchiolitis obliterans organizing pneumonia in patient with systemic lupus erythematosus / 대한내과학회지

Pleuropulmonary manifestations of systemic lupus erythematosus (SLE) are protean and include pleuritis, pulmonary nodule, chronic interstitial pneumonitis, pulmonary hypertension, pulmonary embolism, alveolar hemorrhage, bronchiolitis obliterans (with or without organizing pneumonia), and opportunistic pulmonary infections. Although bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with several connective tissue disorders, there are rare repots of BOOP in patients with SLE. We present a patient with SLE who complained cough and exercise induced dyspnea. Simple chest radiography and high resolution computed tomography (HRCT) of lung were consistent with BOOP and thoracoscopic lung biopsy showed BOOP. Clinical symptoms and radiographic findings were improved after treatment with methylprednisolone pulse and intravenous cyclophosphamide pulse therapy.