RESUMO
A wide variety of cytotoxic medications cause interstitial lung disease (ILD). For the first time, we describe ILD in an 82-year-old woman with muscle invasive bladder cancer 10 days after receiving cetuximab as part of a novel trial. She had no significant medical history or drug allergies, had good exercise tolerance and a 5 pack-year smoking history. She received neoadjuvant chemotherapy (gemcitabine, cisplatin) with a good response on MRI. She was eligible for a phase 2 trial of cetuximab with chemotherapy and radiotherapy for muscle invasive bladder cancer (TUXEDO), in which the trial arm used cetuximab plus standard chemoradiotherapy to the bladder (64 grey in 32 fractions plus mitomycinandfluorouracil). Ten days after her third infusion of cetuximab, she was presented with type 1 respiratory failure. Thoracic CT scan demonstrated new widespread ground glass change in the lungs. She received high-dose steroids (prednisolone 1 mg/kg), broad spectrum antibacterial cover and non-invasive ventilation. She survived to be discharged with residual respiratory failure.
Assuntos
Cetuximab/efeitos adversos , Cetuximab/uso terapêutico , Doenças Pulmonares Intersticiais/induzido quimicamente , Prednisolona/uso terapêutico , Insuficiência Respiratória/induzido quimicamente , Esteroides/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Feminino , Humanos , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/fisiopatologia , Terapia Neoadjuvante , Ventilação não Invasiva , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/fisiopatologia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/fisiopatologia , GencitabinaRESUMO
Diagnosing tuberculous peritonitis can be challenging, with mycobacterial culture potentially taking weeks for a positive result. This report describes 2 cases where a prompt diagnosis of tuberculous peritonitis was made employing the Xpert MTB/RIF assay (Cepheid Inc., Sunnyvale, CA, USA).