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Reactions1433-5Jan2013SSunitinibLungtoxicity:casereportAmandevelopedlungtoxicityduringtreatmentwithsunitinib,anoraldrugusedtotreatmetastatickidneycancer.
Themanpresentedwithnightsweatsandexertionaldyspnoeain2008,at61yearsofage.
Hewasdiagnosedwithmixedconnectivetissuediseasewithpulmonaryfibrosis.
In2009,CTscansshowedatumourinhisleftkidneywithmultiplelungmetastasesandlatero-aorticlymphnodes.
Hehadahigh-grademixedrenal-cellcarcinomawithlymphnodeinvolvement.
Multiplemetastaseswereseen.
InJune2009,hewasstartedonsunitinib50mg/dayfor4weeks.
Thiswasfollowedby2weekswithouttreatment.
Hehadgoodtoleranceofthefirstcycleofsunitinib,butheexperienceddysgeusia,skindesquamation,grade1nauseaandgrade2hypertension.
Threeweeksafterstartingsunitinibtherapy,heexperiencedfeverandpain[ageatreactiononsetnotclearlystated].
Hewastreatedwithceftriaxone,buthisconditionworsened.
Hewasadmittedtointensivecarewithrenalfailureandbreathingdifficulties.
Theman'santibacterialtherapywaschangedtociprofloxacin,cotrimoxazole[trimethoprim/sulfamethoxazole]andtazobactam.
However,hisconditionworsened.
Hewasintubated,andpathologicalexaminationfindingswerecompatiblewithchroniclesionsofinterstitialfibrosisandacutelesionscompatiblewithcryptogenicorganisingpneumonia.
Hewasstartedonclarithromycinandsteroids.
Hisrespiratorystatusimproved,andhewastakenofftheventilator.
Hewasdischargedfromintensivecare,andhisconditionimproved.
Uponfollow-upinOctober2009,hehadnosignsofpneumonitis.
However,hisdiseasehadprogressed.
Hehadpainandaskedtobetreated.
Themanwasstartedonsunitinib25mg,whichwastobegivenfor3daysandstoppedfor3days.
Fourdaysafterstartingtreatment,heexperiencedseveredyspnoea.
BilateralinfiltrateswereseenwithaCTscan.
Hissteroidswereincreased,andfurosemidewasgiven.
Hisconditiondeteriorated,andhedied.
Authorcomment:"Thechronologicalorderoftheeventsseemstopointtoacausaleffectofsunitinibinthispneumonia.
Whenrechallengedwiththedrugthesymptomsreappearedquickly.
"BoyleHJ,etal.
Lungtoxicityinapatienttreatedwithsunitinib.
EuropeanRespiratoryJournal40:1300-1303,No.
5,Nov2012.
Availablefrom:URL:http://dx.
doi.
org/10.
1183/09031936.
00048212-France8030814991Reactions5Jan2013No.
14330114-9954/10/1433-0001/$14.
95Adis2010SpringerInternationalPublishingAG.
Allrightsreserved
Themanpresentedwithnightsweatsandexertionaldyspnoeain2008,at61yearsofage.
Hewasdiagnosedwithmixedconnectivetissuediseasewithpulmonaryfibrosis.
In2009,CTscansshowedatumourinhisleftkidneywithmultiplelungmetastasesandlatero-aorticlymphnodes.
Hehadahigh-grademixedrenal-cellcarcinomawithlymphnodeinvolvement.
Multiplemetastaseswereseen.
InJune2009,hewasstartedonsunitinib50mg/dayfor4weeks.
Thiswasfollowedby2weekswithouttreatment.
Hehadgoodtoleranceofthefirstcycleofsunitinib,butheexperienceddysgeusia,skindesquamation,grade1nauseaandgrade2hypertension.
Threeweeksafterstartingsunitinibtherapy,heexperiencedfeverandpain[ageatreactiononsetnotclearlystated].
Hewastreatedwithceftriaxone,buthisconditionworsened.
Hewasadmittedtointensivecarewithrenalfailureandbreathingdifficulties.
Theman'santibacterialtherapywaschangedtociprofloxacin,cotrimoxazole[trimethoprim/sulfamethoxazole]andtazobactam.
However,hisconditionworsened.
Hewasintubated,andpathologicalexaminationfindingswerecompatiblewithchroniclesionsofinterstitialfibrosisandacutelesionscompatiblewithcryptogenicorganisingpneumonia.
Hewasstartedonclarithromycinandsteroids.
Hisrespiratorystatusimproved,andhewastakenofftheventilator.
Hewasdischargedfromintensivecare,andhisconditionimproved.
Uponfollow-upinOctober2009,hehadnosignsofpneumonitis.
However,hisdiseasehadprogressed.
Hehadpainandaskedtobetreated.
Themanwasstartedonsunitinib25mg,whichwastobegivenfor3daysandstoppedfor3days.
Fourdaysafterstartingtreatment,heexperiencedseveredyspnoea.
BilateralinfiltrateswereseenwithaCTscan.
Hissteroidswereincreased,andfurosemidewasgiven.
Hisconditiondeteriorated,andhedied.
Authorcomment:"Thechronologicalorderoftheeventsseemstopointtoacausaleffectofsunitinibinthispneumonia.
Whenrechallengedwiththedrugthesymptomsreappearedquickly.
"BoyleHJ,etal.
Lungtoxicityinapatienttreatedwithsunitinib.
EuropeanRespiratoryJournal40:1300-1303,No.
5,Nov2012.
Availablefrom:URL:http://dx.
doi.
org/10.
1183/09031936.
00048212-France8030814991Reactions5Jan2013No.
14330114-9954/10/1433-0001/$14.
95Adis2010SpringerInternationalPublishingAG.
Allrightsreserved
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