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Galván OP, Moltó HP, Fabià-Mayans A, Xicoy B, Mate JL, Martí PR. Hydroxyurea-Induced Pneumopathy in a Patient With Myeloproliferative Syndrome. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2018; 11:1179547618770688. [PMID: 29899671 PMCID: PMC5993068 DOI: 10.1177/1179547618770688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/09/2018] [Indexed: 11/18/2022]
Abstract
Hydroxyurea (HU) is a drug frequently used in the treatment of chronic myeloproliferative neoplasms. The most common side effects of this drug are pancytopenia, digestive and skin disorders. Respiratory complications are rare and there are less than 20 cases described, only 5 of which underwent an anatomopathological study. We present the case of a patient with chronic myeloproliferative neoplasm who developed interstitial pneumonitis probably due to HU according to histological study.
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Affiliation(s)
- Oriol Plans Galván
- Department of Intensive and Critical Care, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Hipólito Pérez Moltó
- Department of Intensive and Critical Care, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Blanca Xicoy
- Department of Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - José Luis Mate
- Department of Pathological Anatomy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pilar Ricart Martí
- Department of Intensive and Critical Care, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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2
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Bargagli E, Palazzi M, Perri F, Torricelli E, Rosi E, Bindi A, Pistolesi M, Voltolini L. Fibrotic Lung Toxicity Induced by Hydroxycarbamide. ACTA ACUST UNITED AC 2017; 31:1221-1223. [PMID: 29102950 DOI: 10.21873/invivo.11194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 01/15/2023]
Abstract
A patient treated for 4 months with hydroxycarbamide (hydroxyurea) for chronic myelomonocytic leukemia was admitted to hospital for recently developed severe dyspnea and acute respiratory failure. The computed tomographic scan of the chest showed diffuse ground glass opacities, some centrilobular low-density nodules (resembling hypersensitivity pneumonitis-like pattern), and minimal interstitial reticulation of the subpleural region. The analysis of bronchoalveolar lavage fluid excluded infection, as did serological examinations. The patient was started on oxygen therapy and with relief of thrombocytopenia and suspected hemolytic anemia, hydroxyurea treatment was discontinued. The patient underwent steroid therapy, with a rapid progressive improvement of clinical and radiological features. As hydroxyurea is increasingly used for a number of systemic disorders, physicians must be aware of its potential lung toxicity, requiring immediate cessation of the treatment and empiric corticosteroid therapy.
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Affiliation(s)
- Elena Bargagli
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Marco Palazzi
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Francesco Perri
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Elena Torricelli
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Alessandra Bindi
- Section of Radiology, Careggi University Hospital, Florence, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
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Imai H, Matsumura N, Yamazaki Y, Kanayama Y, Masuda T, Kuwako T, Kamide Y, Tomizawa T, Matsumoto S, Mitsui T, Kaira K, Ono A, Koga Y, Shibusawa N, Sunaga N, Hisada T, Yokoo H, Yamada M. Hydroxyurea-induced Pneumonitis in a Patient with Chronic Myelomonocytic Leukemia: An Autopsy Case. Intern Med 2015; 54:3171-6. [PMID: 26666606 DOI: 10.2169/internalmedicine.54.5069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the case of an 85-year-old man diagnosed with chronic myelomonocytic leukemia whose disease was treated with hydroxyurea for 3 months. He developed respiratory symptoms that were extensively investigated. Despite the intensive treatment, he died of respiratory failure eleven days later. An autopsy revealed diffuse interstitial inflammation of both lungs consistent with drug-induced inflammation. A drug lymphocyte stimulation test was positive for hydroxyurea. Taken together these findings demonstrated that severe interstitial pneumonitis was induced by this drug. Physicians using hydroxyurea must be aware of its potentially life-threatening pulmonary toxicity.
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Affiliation(s)
- Hisao Imai
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
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Girard A, Ricordel C, Poullot E, Claeyssen V, Decaux O, Desrues B, Delaval P, Jouneau S. [Hydroxyurea-induced pneumonia]. Rev Mal Respir 2013; 31:430-4. [PMID: 24878159 DOI: 10.1016/j.rmr.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/26/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hydroxyurea is an antimetabolite drug used in the treatment of myeloproliferative disorders. Common adverse effects include haematological, gastrointestinal cutaneous manifestations, and fever. Hydroxyurea-induced pneumonitis is unusual. CASE REPORT A female patient was treated with hydroxyurea for polycythemia vera. She was admitted 20 days after commencing treatment with a high fever, productive cough, clear sputum and nausea. A chest CT-scan showed diffuse ground-glass opacities. Microbiological investigations were negative. The symptoms disappeared a few days after discontinuation of the drug and rechallenge led to a relapse of symptoms. CONCLUSION Our case and 15 earlier cases of hydroxyurea-induced pneumonitis are reviewed. Two patterns of this disease may exist: an acute febrile form occurring within 1 month of introduction of hydroxyurea and a subacute form without fever. Even if uncommon, one should be aware of this complication of hydroxyurea.
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Affiliation(s)
- A Girard
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - C Ricordel
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - E Poullot
- Service d'hématologie, université de Rennes-1, CHU de Rennes, 35033 Rennes, France
| | - V Claeyssen
- Service des urgences, université de Rennes-1, CHU de Rennes, 35033 Rennes, France
| | - O Decaux
- Service de médecine interne, université de Rennes-1, CHU de Rennes, 35033 Rennes, France
| | - B Desrues
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - P Delaval
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; IRSET UMR 1085, université de Rennes-1, 35043 Rennes, France
| | - S Jouneau
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; IRSET UMR 1085, université de Rennes-1, 35043 Rennes, France
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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