ABSTRACT
We present a case of diffuse alveolar damage (DAD) that occurred in a male aged 68 yrs treated with gemcitabine, a novel antineoplastic agent, that was given for hepatic relapse of a previously resected non-small cell lung cancer. The patient developed acute respiratory failure after the sixth drug dose, and died 4 days after admission. Autopsy revealed a pattern of DAD. No evidence of infection or other specific aetiologies could be found. To our knowledge, only three cases of pulmonary toxicity resulting from treatment with gemcitabine have been published; two of them were fatal and postmortem examination revealed a pattern consistent with acute respiratory distress syndrome. A careful survey may determine the incidence of pulmonary toxicity of this new drug in the future.
Subject(s)
Antimetabolites, Antineoplastic/adverse effects , Deoxycytidine/analogs & derivatives , Pulmonary Alveoli/drug effects , Pulmonary Alveoli/pathology , Aged , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/secondary , Deoxycytidine/adverse effects , Fatal Outcome , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Male , Pulmonary Alveoli/diagnostic imaging , Radiography, Thoracic , Respiratory Insufficiency/chemically induced , GemcitabineABSTRACT
Noninvasive mechanical ventilation has been suggested for the treatment of patients with respiratory failure. We describe the case of a patient affected by bilateral cystic bronchiectasis and acute hypercapnic respiratory failure, due to a cardiogenic pulmonary edema, successfully treated with bi-level nasal-CPAP. This report suggests that in some cases noninvasive ventilatory support may mean avoiding tracheal intubation, even with critically ill patients.
