ABSTRACT
A man in his mid-30s presented to the emergency department with a 1-week history of fatigue, loss of appetite, fever and productive (yellow) cough. This progressed to requiring admission to intensive care needing a oxygen therapy via high-flow nasal cannula for acute hypoxaemic respiratory failure. He had recently started vortioxetine for major depressive disorder, and his acute symptoms correlated with an increase in the dose of vortioxetine. For more than 20 years, rare but consistent reports of serotonergic medications have been implicated in eosinophilic pulmonary conditions. During this same period, serotonergic medications have become a mainstay solution for a wide range of depressive symptoms and disorders. This is the first report of an eosinophilic pneumonia-like syndrome occurring while consuming the novel serotonergic medication vortioxetine.
Subject(s)
Depressive Disorder, Major , Pulmonary Eosinophilia , Respiratory Insufficiency , Male , Humans , Vortioxetine/adverse effects , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/diagnosis , Pulmonary Eosinophilia/chemically induced , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/drug therapy , Syndrome , Respiratory Insufficiency/chemically induced , Respiratory Insufficiency/therapySubject(s)
COVID-19/diagnosis , Daptomycin/adverse effects , Lung/diagnostic imaging , Pulmonary Eosinophilia/diagnosis , Aged, 80 and over , COVID-19/virology , COVID-19 Nucleic Acid Testing , Diagnosis, Differential , Humans , Knee Prosthesis/adverse effects , Male , Prosthesis-Related Infections/drug therapy , Pulmonary Eosinophilia/chemically induced , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Tomography, X-Ray ComputedABSTRACT
Ado-trastuzumab emtansine (T-DM1) is a monoclonal antibody drug conjugate approved for the treatment of HER2-positive breast cancers. Presented here is a case report of a patient who developed fatal pulmonary toxicity in the form of acute eosinophilic pneumonia while undergoing treatment with T-DM1. Prior to beginning T-DM1 therapy, this patient had been treated with two HER2-targeted agents (trastuzumab, pertuzumab) per National Comprehensive Cancer Network (NCCN) guidelines. This case represents a novel presentation of toxicity associated with T-DM1 while perhaps demonstrating additive toxicity associated with multiple lines of HER2 targeted therapies.