A37. CASE REPORTS: DRUG TOXICITY最新文献

{"title":"Pembrolizumab-Induced Sarcoidosis: A Case Report","authors":"C. Walmsley, T. Sibert, S. Summers","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1392","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1392","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125433105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Eosinophilic Pneumonia - A Challenging Case with Multiple Triggers","authors":"F. Das Gracas, F. Nitol, K. Gafoor","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1391","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1391","url":null,"abstract":"Introduction Eosinophilic pneumonia is a class of lung diseases characterized by accumulation of eosinophils in the lung. Chronic eosinophilic pneumonia (CEP) is diagnosed through radiographic imaging and bronchoalveolar lavage (BAL) with elevated eosinophil count (>25%) in the setting of pulmonary symptoms for more than 2 weeks. While CEP is often an idiopathic disease, it may also be caused by medications, illicit substances, or infections. Identifying the trigger is imperative for successful treatment. A 71-year-old man presented with fever and chronic shortness of breath that started after COVID-19 infection (6 months prior to presentation). Medical history was also significant for multiple myeloma, asthma, hypertension, type 2 diabetes, coronary artery disease, chronic kidney disease, and Alzheimer's dementia. Current medications included bortezomib, pomalidomide, aspirin, clopidogrel , donepezil, tramadol and insulin. Lenalidomide was discontinued 3 months prior due to generalized skin rash and high peripheral eosinophilia (19%). On presentation, physical exam revealed mild respiratory distress, bibasilar crackles, and bilateral pedal edema. Long COVID Syndrome was suspected. He was started on antibiotics and diuretics with no improvement. Labs revealed mild peripheral eosinophilia. Chest X-ray showed diffuse bilateral reticular nodular opacities predominantly on the right. CT chest revealed reticulonodular infiltrates in both lungs predominantly in the right upper lobe with small pleural effusion. Bronchoscopy with BAL was negative for infection but revealed 28% eosinophils. Pomalidomide was discontinued and oral prednisone started. Discussion: CEP is part of a group of eosinophilic lung diseases characterized by abnormal accumulation of eosinophils in the lung tissue. Symptoms include dyspnea and cough in the majority of cases, but may also include fever, sinusitis, rhinitis, fatigue and weight loss. The radiographic hallmarks are bilateral alveolar infiltrates peripherally predominantly in the upper lobes and may be ground glass or consolidation. The presence of an elevated eosinophil count (>25%) in a BAL confirms the diagnosis. Though often idiopathic, identification of possible causes is important for proper management. In our case, the patient has multiple risk factors including possible Long COVID Syndrome and malignancy. Medications such as bortezomib, lenalinomide and pomalidomide have been known to cause diffuse lung injury. To the best of our knowledge there is one case report illustrating Lenalinomide related CEP. History of asthma is present in most cases of idiopathic CEP. Our patient had multiple potential triggers for CEP. We suspect that CEP was medication-related in this case. (Figure Presented).","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122085298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not All That Is Pneumocystis Jirovecii Pneumonia (PCP) Is HIV: A Case of Drug Predisposed PCP Due to Initiation of Tocilizumab in an HIV Negative Patient","authors":"D. Walsh, N. Ravikumar","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1394","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1394","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124812534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dasatinib Induced Pneumonitis","authors":"S. Chandna, M. Shah, K. Raj, S. Bhasin, D. Ngo","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1412","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1412","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124368313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Hydroxyurea-Induced Interstitial Pneumonitis","authors":"C. Williams, S. Patel, N. McDonald, V. Patel","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1393","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1393","url":null,"abstract":"Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile.","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"6 23","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120808700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Ou Gon Too Far: A Cautionary Tale of Supplement Use","authors":"M. Forster, C. Motschwiller, M. F. Sloane","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1390","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1390","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"31 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120840960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Organizing Pneumonia Developed After COVID-19 Vaccine","authors":"J. Ryoo, H. Cho, J. Lee, C. Rhee, S.J. Kim, S. Kim, S. Lee, Y. Kim, J. Kang","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1417","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1417","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127274921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaping Induce Pneumonitis: Missed in Pandemic","authors":"A. Iftikhar, M. Patel, M. Cheema, A. Adial","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1400","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1400","url":null,"abstract":"Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly emergent coronavirus, that was first recognized in Wuhan, Hubei province, China, in December 2019. SARS-CoV-2 is a positive-sense singlestranded RNA virus that is contagious in humans. E-cigarette or vaping product use-associated lung injury (EVALI) is a type of acute lung injury of unclear pathogenesis. The two pathologies present with overlapping clinical symptoms, and imaging, making them difficult to distinguish, especially in global COVID-19 pandemic. Case report: 27-year-old female with past medical history of IBS, Diverticulitis, and anxiety presented with cough, shortness of breath, fever and fatigue. She also reported headaches and abdominal pain, she denies sick contact and recent travel but admit that she uses E cigarette more than usual due to anxiety attack. Patients initially discharge from ED but subsequently admit to hospital for worsening of symptoms possible COVID pneumonia vs community acquired pneumonia. She was persistently hypoxic and transfer to ICU for acute hypoxic respiratory failure. Labs was significant for elevated WBC while serum chemistries were unremarkable, Chest x-ray was not significant for any acute pathology. CT scan show revealed parenchymal changes consistent with bilateral upper and lower lobe ground-glass opacities. No septal change was noted, helping us rule out causes such as organizing pneumonia, lipoid pneumonia, and diffuse alveolar damage. Extensive testing for viral and bacterial infections was all negative. she has Covid19 PCR negative twice. Bronchoalveolar lavage testing was not done as patient refuse for invasive intervention. Patient started on steroids. Discussion: EVALI is thought to be a type of acute lung injury with an unknown pathogenesis. E-cigarette use, especially those containing THC and/or vitamin E acetate, is a key risk factor for developing the disease process. COVID 19 pneumonitis and EVALI have same clinical presentation, laboratory studies and images, and make challenge for physician to differentiate both pathologies. Both disease present with similar initial symptoms, including cough, shortness of breath, fevers, vomiting, diarrhea and headache. Similarly, laboratory studies may be unremarkable or elevated in both presentations and do not help distinguish between them. Furthermore, Chest X-ray and CT have very similar findings in both presentations, including diffuse hazy or consolidative opacities and ground-glass opacities, respectively. As well, both COVID-19 and EVALI are associated with worse outcomes in older adults or those with underlying chronic conditions, including cardiac and pulmonary disease.","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125930448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoidosis-Like Reaction Secondary to Infliximab","authors":"P. M. Cavalcante Neto, M. R. Soares, M. Castro, S.L.K. Matias, A. Resende, S.A.E.H.C. Silva, M. Cerezoli, G. Miranda, C. Fukuda, V. Arida, R. Ferreira, I. Missrie, C. Pereira","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1421","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1421","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131239602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Leflunomide-Induced Pulmonary Nodulosis","authors":"R. Gómez, S. Wong","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1409","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1409","url":null,"abstract":"","PeriodicalId":294658,"journal":{"name":"A37. CASE REPORTS: DRUG TOXICITY","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114769264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}