Organizing pneumonia secondary to cetuximab in a patient with colorectal cancer

  • Abdulaziz AlGhulayqah Department of Medicine, Qassim University; Department of Medicine, Section of Pulmonary, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Bader AlShamsan Department of Medicine, Qassim University; Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Shouki Bazarbashi Department of Medicine, Section of Pulmonary, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Shamayel Mohammed Department of Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Abdullah Mobeireek | mobeireek@yahoo.com Department of Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Abstract

Organizing pneumonia (OP) may be idiopathic or secondary to a variety of causes including drugs. OP and other forms of pulmonary toxicity secondary to cetuximab, however, have been described rarely. It is paramount to recognize and differentiate OP from other common conditions that cancer patients are prone to such as infection and pulmonary embolism. A 69-year-old man with colorectal cancer received ten cycles of palliative chemotherapy [FOLFIRI (5-Fluorouracil, Leucovorin, Irinotecan) and cetuximab] with clinical and radiological response. He developed dyspnea following cycle 4, then 6 weeks later presented with cough, fever, tachypnea, hypoxia, bilateral crackles and diffuse pulmonary shadows. He was started on antibiotics but his condition deteriorated further. Cultures, including blood and bronchioalveolar lavage, grew no pathogens and molecular analysis and cytology for bacteria viruses were negative. Trans-bronchial biopsy was consistent with organizing pneumonia. Treatment with corticosteroids resulted in dramatic clinical and radiological resolution with normalization of gas exchange and pulmonary function. Corticosteroids were stopped and he was restarted on FOLFIRI and remained well with no relapse over a year of follow up. Although pulmonary toxicity secondary to cetuximab is uncommon, it is important to recognize, as it may be associated with poor prognosis. To the best of our knowledge, this is the first report of OP attributed to cetuximab with histopathological evidence.

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Published
2019-09-11
Info
Issue
Section
Pneumology - Case Reports
Keywords:
Organizing pneumonia, cetuximab, colorectal cancer
Statistics
  • Abstract views: 455

  • PDF: 353
How to Cite
AlGhulayqah, A., AlShamsan, B., Bazarbashi, S., Mohammed, S., & Mobeireek, A. (2019). Organizing pneumonia secondary to cetuximab in a patient with colorectal cancer. Monaldi Archives for Chest Disease, 89(3). https://doi.org/10.4081/monaldi.2019.1074