RESUMEN
Invasive fungal infections are a major cause of morbidity and mortality in allogeneic stem cell transplant recipients. They can occasionally involve the tracheobronchial tree with serious clinical consequences. Tracheobronchial involvement is often an unexpected finding during diagnostic bronchoscopy. Herein, we report a case of pseudomembranous tracheobronchitis caused by Rhizopus sp. in an allogeneic stem cell transplant recipient.
Asunto(s)
Bronquitis/microbiología , Huésped Inmunocomprometido , Mucormicosis/inmunología , Trasplante de Células Madre/efectos adversos , Traqueítis/microbiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Bronquitis/inmunología , Bronquitis/patología , Broncoscopía , Resultado Fatal , Enfermedad Injerto contra Huésped/complicaciones , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Humanos , Leucemia Linfocítica Crónica de Células B/terapia , Masculino , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Mucormicosis/patología , Náusea/etiología , Insuficiencia Respiratoria/microbiología , Rhizopus/aislamiento & purificación , Traqueítis/inmunología , Traqueítis/patología , Trasplante HomólogoRESUMEN
Pomalidomide is an immunomodulatory derivative (IMiD) active in multiple myeloma. In this report, we review the course of two patients receiving pomalidomide therapy who subsequently developed dyspnea, fever, hypoxia, and ground-glass opacities on CT scan. An extensive workup for infectious causes was negative. Both patients improved with discontinuation of the medication and/or treatment with corticosteroids. Both patients were restarted on pomalidomide therapy at a lower dose, with one patient experiencing an immediate recurrence of pulmonary symptoms. The combination of symptoms, radiographic findings, clinical course, and response to treatment strongly supports the diagnosis of acute pulmonary toxicity secondary to pomalidomide. We then review previously published pulmonary toxicity data on thalidomide and lenalidomide and compare the described clinical courses, radiographic findings, and responses to treatment with those observed in our patients. We conclude that pulmonary toxicity is a potential adverse effect of pomalidomide therapy and encourage physicians to remain cognizant of its clinical presentation.
Asunto(s)
Antineoplásicos/efectos adversos , Enfermedades Pulmonares/inducido químicamente , Pulmón/efectos de los fármacos , Mieloma Múltiple/tratamiento farmacológico , Talidomida/análogos & derivados , Enfermedad Aguda , Anciano , Femenino , Humanos , Pulmón/patología , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Radiografía , Talidomida/efectos adversosRESUMEN
Hyper IgG4 disease is a recently described inflammatory disease characterized by lymphoplasmacytic infiltration leading to fibrosis and tissue destruction. Whereas most cases have been successfully treated with corticosteroids, recurrent or refractory cases may benefit from alternative therapies. Bortezomib has proven to be successful in the treatment of multiple myeloma, and its mechanism indicates that it may have merit in autoimmune or other plasmacytic disorders. We report a patient with recurrent pulmonary infiltration with IgG4 plasma cells, consistent with hyper IgG4 disease, who was successfully treated using a bortezomib-based combination with minimal therapy-related toxicities.