Aspergillosis superinfection as a cause of death of crizotinib-induced interstitial lung disease successfully treated with high-dose corticosteroid therapy.

Crizotinib is an efficacious and well-tolerated drug in the management of ALK-positive lung cancer. Crizotinib treatment, however, is rarely complicated by the occurrence of acute interstitial lung disease (ILD) that is often fatal. There is no treatment for this serious adverse event. We report a female non-small cell lung cancer patient who developed ILD after a few days of crizotinib therapy. She showed a significant improvement after a high dose of pulse corticosteroid therapy, both radiologically and clinically. Unfortunately, the patient subsequently developed an aspergillosis superinfection leading to death. Our experience suggests that high-dose steroid therapy may be efficacious in the management of a severe complication of crizotinib therapy. However, potent antifungal therapy should be considered to prevent the risk of severe aspergillosis.

An Outbreak of Acute Beryllium Disease in a Compound Metal Alloy Factory / 대한산업의학회지

OBJECTIVES: We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease. METHODS: The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography. RESULTS: The air concentrations of beryllium ranged from 0.42 microgram/m3 to 112.3 microgram/m3, and the mean concentration of urinary beryllium were 1.53+/-0.79 microgram/g of creatinine in the molding workers, 1.41+/- 0.50 microgram/g of creatinine in the casting workers, and 1.16+/-0.53 microgram/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (p=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (p=0.012). The time of employment for all patients was prior to December 1st, 2002. CONCLUSIONS: Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

An Outbreak of Acute Beryllium Disease in a Compound Metal Alloy Factory / 대한산업의학회지

OBJECTIVES: We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease. METHODS: The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography. RESULTS: The air concentrations of beryllium ranged from 0.42 microgram/m3 to 112.3 microgram/m3, and the mean concentration of urinary beryllium were 1.53+/-0.79 microgram/g of creatinine in the molding workers, 1.41+/- 0.50 microgram/g of creatinine in the casting workers, and 1.16+/-0.53 microgram/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (p=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (p=0.012). The time of employment for all patients was prior to December 1st, 2002. CONCLUSIONS: Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

Carbamazepine-induced Acute Interstitial Lung Disease

Seven days after starting carbamazepine therapy because of a central pain, a 67-year old man with the occlusion of left middle cerebral artery developed acute interstitial lung disease with severe dyspnea and decreased consciousness. Initial therapy included mechanical ventilation, discontinuation of carbamazepine, and injection with epinephrine and steroid. Five days after developing the acute interstitial lung disease, his clinical status and the finding of simple chest X-ray were markedly improved. Several days later, there was the removal of the ventilator and resolution of pulmonary symptoms. Acute interstitial lung disease is a rare fatal adverse reaction to carbamazepine therapy. However, awareness of carbamazepine-induced lung disease may reduce delays in both diagnosis and withdrawal of the drug.