RESUMO
Gefitinib (ZD1839), a small-molecule epidermal growth factor receptor tyrosine kinase inhibitor, is an anticancer agent for patients with non-small cell lung carcinoma. Recently, however, as a result of accumulating evidence, it has been recognized that gefitinib can give rise to lethal lung toxicity. The authors report a case of interstitial lung disease (ILD) induced by gefitinib, which improved promptly following cessation of the administration of the agent. Clinical signs suggesting a good prognosis were noted, namely, findings similar to acute eosinophilic pneumonia on CT and a disassociation in the elevation of specific serum markers of ILD. At the time of onset of ILD, serum concentrations of surfactant protein (SP)-A and SP-D were significantly increased, whereas that of KL-6 was not increased. A previous study of three cases of lethal lung toxicity resulting from gefitinib administration revealed a significant and almost equal increase in KL-6, SP-A and SP-D. These results suggest that SP-A and SP-D may be indicators of gefitinib-induced ILD and that KL-6 is a predictor of outcome. Using a combination of these markers may help to establish a differential prognosis in patients with gefitinib-induced ILD.
Assuntos
Antineoplásicos/efeitos adversos , Doenças Pulmonares Intersticiais/induzido quimicamente , Proteína A Associada a Surfactante Pulmonar/sangue , Proteína D Associada a Surfactante Pulmonar/sangue , Quinazolinas/efeitos adversos , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Antígenos de Neoplasias/sangue , Antineoplásicos/uso terapêutico , Biomarcadores/sangue , Biópsia , Feminino , Gefitinibe , Humanos , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Mucina-1 , Mucinas/sangue , Quinazolinas/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
A rare case of 49-year-old woman having pulmonary bronchogenic cyst associated with bronchial atresia in the same lobe was presented. The diagnosis was confirmed by aortography and operation specimen. Three-dimensional reconstructed images of computed tomography clearly demonstrated the defference between mucoid impaction of bronchial trees in the left S9 not communicating with hilar bronchus and the cyst in the left S10 oppressing surrounding vessels.
Assuntos
Brônquios/anormalidades , Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico , Anormalidades Congênitas/diagnóstico , Pneumopatias/complicações , Pneumopatias/diagnóstico , Adulto , Aortografia , Biópsia por Agulha , Cisto Broncogênico/cirurgia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Pneumopatias/cirurgia , Pessoa de Meia-Idade , Pneumonectomia/métodos , Radiografia Torácica , Doenças Raras , Medição de Risco , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
This is the first report suggesting a causal relationship between acute respiratory distress syndrome and Hericium erinaceum extract, which is commercialized as a diet food. A 63-year-old man was admitted to our hospital for intensive care of severe acute respiratory failure with diffuse infiltration in both lungs. Bronchoalveolar lavage fluid revealed a high percentage of lymphocytes. Lymphocyte stimulation test showed a strong reactivity against extract formulation of Hericium erinaceum (Yamabushitake), which he had taken four months before onset. He recovered with successful steroid pulse therapy under mechanical ventilation. Concentrations of surfactant protein (SP)-A and SP-D in sera reflected the clinical features.