ABSTRACT
Abstract Herpetic whitlow is a viral infection of the fingers caused by the herpes simplex virus. The disease has a bimodal age distribution, affecting children under 10 years of age and young adults between 20 and 30 years old. It can be easily mistaken for panaritium or bacterial cellulitis. In patients with AIDS, atypical, chronic and recurrent ulcerated lesions occur. The Tzanck test allows a quick and low-cost diagnosis of herpes simplex virus infection. The authors report the case of a child with AIDS with painful finger ulcers in which the diagnosis was confirmed by the Tzanck test.
Subject(s)
Humans , Psoriasis/chemically induced , Psoriasis/drug therapy , Lung Diseases, Interstitial/chemically induced , Tumor Necrosis Factor-alpha , Adalimumab/adverse effects , Tumor Necrosis Factor Inhibitors , Middle AgedABSTRACT
Abstract Psoriasis is a chronic inflammatory disease that affects the skin variably, according to genetic and environmental factors. Some patients may benefit from systemic treatment with immunobiological agents, drugs that can be accompanied by several adverse effects. A case of a 58-year-old patient undergoing treatment for psoriasis with adalimumab for five years is reported. Alterations compatible with interstitial pneumonia were detected with important regression after adalimumab discontinuation. This case is relevant due to the scarcity of reports on late pulmonary adverse effect of anti-TNF treatment of psoriasis.
Subject(s)
Humans , Psoriasis/chemically induced , Psoriasis/drug therapy , Lung Diseases, Interstitial/chemically induced , Tumor Necrosis Factor-alpha , Adalimumab/adverse effects , Tumor Necrosis Factor Inhibitors , Middle AgedABSTRACT
Drug rash with eosinophilia and systemic symptoms or DRESS Syndrome is a rare, serious and potentially fatal adverse drug reaction. It is characterized by widespread morbilliform and edematous skin lesions, associated with eosinophilia, lymphadenopathy and internal organ involvement and unusually associated with pulmonary symptoms. We report a 47-year-old male with DRESS syndrome, manifested with typical skin lesions and extensive pulmonary involvement, responding satisfactorily to systemic corticosteroids.
Subject(s)
Humans , Male , Middle Aged , Lung Diseases, Interstitial/chemically induced , Lung Diseases, Interstitial/pathology , Drug Hypersensitivity Syndrome/pathology , Penicillin G Benzathine/adverse effects , Dipyrone/adverse effects , Treatment Outcome , Adrenal Cortex Hormones/therapeutic use , Lung Diseases, Interstitial/drug therapy , Antipyretics/adverse effects , Drug Hypersensitivity Syndrome/drug therapy , Anti-Bacterial Agents/adverse effectsABSTRACT
Objective: To identify the risk factors and clinical features associated with the interstitial pneumonia in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) or rituximab, cyclophosphamide, liposomal doxorubicin, vincristine and prednisone (RCDOP) regimens. Methods: A retrospective study was conducted in 836 patients with DLBCL admitted to the Department of Hematology at Ruijin Hospital from 2013 to 2018. Among them, 114 patients were treated with RCDOP regimen. Using the method of propensity score matching according to age, gender, IPI score of patients, 114 patients treated with RCHOP regimen were selected as controls. Clinical data, including comorbidities, gender, age, B symptoms, international prognostic index (IPI) score, disease stage, serum lactic dehydrogenase (LDH) and β(2) microglobulin (β(2)-MG) level were collected and the risk factors of interstitial pneumonia were further analyzed. Results: The interstitial pneumonia developed more frequently in RCDOP group than RCHOP group (28.95% vs 2.60%, P<0.01) . As the dose of liposomal doxorubicin elevated from 25-30 mg/m(2) to 35-40 mg/m(2), the incidence of interstitial pneumonia accordingly increased from 17.30% to 38.71% (P<0.05) . By multivariate analysis, disease stage was an independent factor of interstitial pneumonitis. Conclusions: Front line regimens containing liposomal doxorubicin in DLBCL patients link to a higher incidence of dose-dependent interstitial pneumonia. Prevention and surveillance should be emphasized in future studies.
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cyclophosphamide , Doxorubicin , Lung Diseases, Interstitial/chemically induced , Lymphoma, Large B-Cell, Diffuse/drug therapy , Prednisone , Retrospective Studies , Rituximab , VincristineABSTRACT
Summary A 66-year-old male patient was referred to our clinic with severe pneumonia. Bronchoscopy was performed due to clinical worsening despite antibiotics and diuretic therapy, respiratory failure and radiographic progression. Because bacterial cultures of the bronchoalveolar lavage fluid were negative and after using amiodarone for almost one month, we eliminated amiodarone from his medication regimen due to suspicion of amiodarone toxicity. Accordingly, we also initiated systemic steroid therapy. Chest X-ray done after 72 hours showed a significant resolution of lung consolidations and the patient exhibited significant clinical improvement, with decline of his oxygen requirements.
Subject(s)
Humans , Male , Aged , Respiratory Insufficiency/chemically induced , Vasodilator Agents/adverse effects , Lung Diseases, Interstitial/chemically induced , Amiodarone/adverse effects , Pneumonia/chemically induced , Pneumonia/diagnostic imaging , Respiratory Insufficiency/diagnostic imaging , Radiography, Thoracic , Lung Diseases, Interstitial/diagnostic imaging , Lung/drug effectsABSTRACT
Maximum androgen blockade is the standard endocrine treatment for advanced prostate cancer. Interstitial lung disease in different degrees of severity, with low mortality and excellent response to treatment may appear with its use. We report a 77 years old patient with advanced prostate cancer who developed severe and progressive respiratory failure associated to bilateral pulmonary infiltrates, attributed to the direct effect of maximum androgen blockade. Despite the therapeutic efforts, the patient died. Lung pathology revealed Usual Interstitial Pneumonia.
Subject(s)
Humans , Male , Aged , Lung Diseases, Interstitial/chemically induced , Androgen Antagonists/adverse effects , Antinematodal Agents/adverse effects , Prostatic Neoplasms/drug therapy , Tosyl Compounds/adverse effects , Biopsy , Adenocarcinoma/drug therapy , Tomography, X-Ray Computed , Lung Diseases, Interstitial/pathology , Fatal Outcome , Disease Progression , Anilides/adverse effects , Nitriles/adverse effectsABSTRACT
From 2006 to 2011, an outbreak of a particular type of childhood interstitial lung disease occurred in Korea. The condition was intractable and progressed to severe respiratory failure, with a high mortality rate. Moreover, in several familial cases, the disease affected young women and children simultaneously. Epidemiologic, animal, and post-interventional studies identified the cause as inhalation of humidifier disinfectants. Here, we report a 4-year-old girl who suffered from severe progressive respiratory failure. She could survive by 100 days of extracorporeal membrane oxygenation support and finally, underwent heart-lung transplantation. This is the first successful pediatric heart-lung transplantation carried out in Korea.
Subject(s)
Child, Preschool , Female , Humans , Disinfectants/toxicity , Extracorporeal Membrane Oxygenation , Humidifiers , Lung/drug effects , Lung Diseases, Interstitial/chemically induced , Lung Transplantation , Republic of Korea , Respiratory Rate , Retrospective Studies , Thorax/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can effi ciently decrease serum methotrexate concentration. A rapid improvement of clinical symptoms and resolution of pulmonary opacifi cation were found after CRRT. Blood cell counts returned to normal after component blood transfusion and cytokine supportive therapy. Patients with impaired renal function are at high risk of methotrexate toxicity, and low-dose methotrexate should be prescribed with great caution.
.Subject(s)
Humans , Male , Middle Aged , Dermatologic Agents/adverse effects , Lung Diseases, Interstitial/chemically induced , Methotrexate/adverse effects , Pancytopenia/chemically induced , Pemphigoid, Bullous/drug therapy , Dermatologic Agents/administration & dosage , Kidney Failure, Chronic/therapy , Lung Diseases, Interstitial/therapy , Methotrexate/administration & dosage , Pancytopenia/therapy , Renal Dialysis , Risk Factors , Treatment OutcomeABSTRACT
No abstract available.
Subject(s)
Adult , Female , Humans , Antineoplastic Agents/adverse effects , Antitubercular Agents/therapeutic use , Biopsy , Gastrointestinal Stromal Tumors/drug therapy , Imatinib Mesylate/adverse effects , Lung Diseases, Interstitial/chemically induced , Mycobacterium tuberculosis/isolation & purification , Protein Kinase Inhibitors/adverse effects , Rectal Neoplasms/drug therapy , Tomography, X-Ray Computed , Tuberculosis, Pulmonary/diagnosisABSTRACT
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.
A venlafaxina é um inibidor de recaptação de serotonina e noradrenalina utilizado como antidepressivo. A variabilidade individual ou interações entre fitoterápicos e fármacos podem causar toxicidade induzida por drogas. Relatamos o caso de uma paciente de 35 anos diagnosticada com pneumonite intersticial e miocardiopatia dilatada atribuídas à venlafaxina. A paciente procurou atendimento médico devido a dispneia e tosse seca, que começaram três meses após iniciar tratamento com venlafaxina para depressão. Concomitantemente tomava suplementos fitoterápicos contendo Centella asiatica e Fucus vesiculosus. A radiografia e a CT de tórax revelaram doença pulmonar parenquimatosa (micronódulos difusos e opacidades em vidro fosco) e, simultaneamente, foi diagnosticada uma miocardiopatia por ecocardiograma, que revelou uma fração de ejeção ventricular esquerda (FEVE) de 21%. Uma investigação ampla foi realizada, incluindo LBA, estudos de imagem, detecção de doenças autoimunes, cateterismo cardíaco direito e biópsia miocárdica. Após a exclusão de outras etiologias e a aplicação da Escala de Probabilidade de Reações Adversas a Medicamentos de Naranjo, foi assumido o diagnóstico de pneumonite/miocardiopatia síncronas associadas à venlafaxina. Já foi demonstrado que os suplementos fitoterápicos utilizados pela paciente podem inibir a isoenzima do complexo enzimático citocromo P450, responsável pelo metabolismo da venlafaxina. Após a descontinuação da venlafaxina, verificou-se uma rápida melhora clínica com regressão das alterações radiológicas e normalização da FEVE. Este é um importante caso de toxicidade cardiopulmonar induzida por droga. A administração circunstancial de inibidores da isoenzima CYP2D6 e a presença de um fenótipo de metabolização lenta de CYP2D6 podem ter resultado na acumulação tóxica da venlafaxina e na manifestação clínica subsequente. Aqui, é discutida a hipótese de a fosfolipidose macrofágica ser o mecanismo de toxicidade.
Subject(s)
Adult , Female , Humans , Antidepressive Agents, Second-Generation/adverse effects , Cardiomyopathies/chemically induced , Cyclohexanols/adverse effects , Lung Diseases, Interstitial/chemically induced , Cardiomyopathies/diagnosis , Depressive Disorder/drug therapy , Lung Diseases, Interstitial/diagnosisABSTRACT
The use of immunobiological agents for the treatment of autoimmune diseases is increasing in medical practice. Anti-TNF therapies have been increasingly used in refractory autoimmune diseases, especially rheumatoid arthritis, with promising results. However, the use of such therapies has been associated with an increased risk of developing other autoimmune diseases. In addition, the use of anti-TNF agents can cause pulmonary complications, such as reactivation of mycobacterial and fungal infections, as well as sarcoidosis and other interstitial lung diseases (ILDs). There is evidence of an association between ILD and the use of anti-TNF agents, etanercept and infliximab in particular. Adalimumab is the newest drug in this class, and some authors have suggested that its use might induce or exacerbate preexisting ILDs. In this study, we report the first case of acute ILD secondary to the use of adalimumab in Brazil, in a patient with rheumatoid arthritis and without a history of ILD.
O uso de imunobiológicos no tratamento das doenças autoimunes é cada vez mais frequente na prática médica. Terapias anti-TNF têm sido cada vez mais utilizadas nas doenças autoimunes refratárias, especialmente na artrite reumatoide, com resultados promissores. Entretanto, o uso dessas terapias está relacionado ao aumento do risco do desenvolvimento de outras doenças autoimunes. Adicionalmente, o uso de agentes anti-TNF pode determinar repercussões pulmonares, como a reativação de infecções por micobactérias e fungos e o desenvolvimento de sarcoidose e de outras doenças pulmonares intersticiais (DPIs). A associação de DPI e uso dos agentes anti-TNF, em especial infliximabe e etanercepte, já foi descrita. O adalimumabe é a mais nova droga dessa classe, e algumas publicações sugerem que seu uso pode determinar a indução ou mesmo a exacerbação de DPIs preexistentes. Neste estudo, relatamos o primeiro caso de DPI aguda secundária à utilização de adalimumabe, em uma paciente portadora de artrite reumatoide sem DPI prévia no Brasil.
Subject(s)
Female , Humans , Middle Aged , Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Lung Diseases, Interstitial/chemically induced , Arthritis, Rheumatoid/drug therapyABSTRACT
Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.
O pneumomediastino espontâneo é um evento incomum, cujo quadro clínico inclui dor pleurítica retroesternal, enfisema subcutâneo, dispneia e disfonia. O mecanismo fisiopatológico implicado é o surgimento de uma diferença de pressão entre os alvéolos e estruturas adjacentes, ocasionando ruptura alveolar com posterior dissecção da bainha peribroncovascular e infiltração do mediastino e do tecido subcutâneo pelo ar. Desencadeantes conhecidos incluem exacerbação aguda de asma e situações que exigem a realização de manobra de Valsava. Descrevemos e documentamos por imagens tomográficas a ocorrência de pneumomediastino após a realização de prova de função pulmonar em um paciente com pneumopatia intersticial induzida por bleomicina. Apesar de incomum, a associação entre provas de função pulmonar e síndromes de vazamento de ar tem sido relatada cada vez mais na literatura, e doenças pulmonares, como as pneumopatias intersticiais, contemplam alterações estruturais que facilitam a ocorrência da complicação. .
Subject(s)
Humans , Male , Middle Aged , Antibiotics, Antineoplastic/adverse effects , Bleomycin/adverse effects , Emphysema/etiology , Lung Diseases, Interstitial/chemically induced , Pneumothorax/etiology , Respiratory Function Tests/adverse effects , Fatal Outcome , Tomography, X-Ray ComputedABSTRACT
La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.
The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.
Subject(s)
Aged , Female , Humans , Antibodies, Monoclonal, Murine-Derived/adverse effects , Antineoplastic Agents/adverse effects , Lung Diseases, Interstitial/chemically induced , Lung Diseases, Interstitial , Lymphoma, Follicular/drug therapy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.
Subject(s)
Child, Preschool , Humans , Infant , APACHE , Bronchi/pathology , Cough/etiology , Cyclophosphamide/therapeutic use , Disinfectants/toxicity , Dyspnea/etiology , Enzyme Inhibitors/therapeutic use , Hydroxychloroquine/therapeutic use , Immunoglobulins/therapeutic use , Inhalation , Lung Diseases, Interstitial/chemically induced , Prognosis , Retrospective Studies , Steroids/therapeutic use , Tomography, X-Ray ComputedABSTRACT
The effective and toxic ranges of anticancer drugs are very narrow and, in some cases, inverted. Thus determination of the most appropriate dosage and schedule of administration is crucial for optimal chemotherapy. In common arm trials conducted in Japan and by Southwest Oncology Group (SWOG) that used the same doses and schedules for the administration of carboplatin plus paclitaxel, the frequency of hematological toxicity was significantly higher in the Japanese trials than in the SWOG trial, despite demonstrating similar response rates. The frequency of epidermal growth factor receptor (EGFR) mutations in tumors was significantly higher among East Asian populations, and these populations are also reported to demonstrate a higher response rates to epidermal growth factor receptor tyrosine-kinase inhibitors (EGFR-TKIs). The prevalence of interstitial lung disease induced by treatment with EGFR-TKIs has been shown to be quite high in the Japanese population. Clinical trials of cetuximab against non-small cell lung cancer and of bevacizumab against stomach cancer have shown that these agents are only active in Caucasians. In a trial examining the use of sorafenib after transarterial chemoembolization in Korean and Japanese patients with advanced hepatocellular carcinoma, the compliance and dose intensity of the drug were quite low compared with other trials. Although not only identified pharmacogenomics differences but also differences in social environment, and regional medical care, including pharmacoeconomics strongly influence ethnic differences in treatment response, further identification and understanding of the pharmacogenomics underlying ethnic differences will be essential to timely and reliable global development of new anticancer drugs.
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Asian People , Carcinoma, Non-Small-Cell Lung/drug therapy , Chemoembolization, Therapeutic , Clinical Trials as Topic , Drug Design , Ethnicity , Japan , Lung Diseases, Interstitial/chemically induced , Lung Neoplasms/drug therapy , Mutation , Pharmacogenetics/methods , ErbB Receptors/genetics , Republic of KoreaABSTRACT
After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.
Subject(s)
Female , Humans , Middle Aged , Antiviral Agents/adverse effects , Bronchoalveolar Lavage , Hepatitis C, Chronic/complications , Interferon-alpha/adverse effects , Kidney Failure, Chronic/complications , Lung Diseases, Interstitial/chemically induced , Respiratory Function Tests , Tomography, X-Ray ComputedABSTRACT
A 63-year-old female diagnosed with relapsed multiple myeloma visited our hospital complaining of a persistent cough. Since July 2006, she had been taking 100 mg thalidomide daily and gradually developed shortness of breath and a persistent dry cough. A chest X-ray and computed tomography showed ground glass opacities in both lungs. An open lung biopsy of the right middle lobe under general anesthesia revealed chronic peribronchial inflammation, mild interstitial fibrosis, and intra-alveolar macrophage infiltration, with some hemosiderin features, compatible with non-specific interstitial pneumonia (NSIP). After discontinuing the thalidomide, the patient's symptoms did not deteriorate, although the radiographs did not improve. The patient is alive and well with regular outpatient follow-up without progression of the NSIP.
Subject(s)
Female , Humans , Middle Aged , Lung Diseases, Interstitial/chemically induced , Multiple Myeloma/drug therapy , Thalidomide/adverse effectsABSTRACT
BACKGROUND/AIMS: The aim of our study was to determine the incidence and clinical features of severe pulmonary complications in patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) as the initial treatment for lymphoma. METHODS: A retrospective analysis of pulmonary infection and drug-induced interstitial pneumonitis (DIIP) was performed using lymphoma registry data. R-CHOP was administered in 71 patients and CHOP in 29 patients. RESULTS: The severe pulmonary adverse events tended to occur more frequently with R-CHOP (18.3%) than CHOP alone (13.8%), although the difference was not significant (p = 0.771). DIIP occurred in five patients in the R-CHOP arm (7%) and in one in the CHOP arm (3%). The continuous use of steroids for conditions other than lymphoma significantly increased the risk of pulmonary infection including Pneumocystis jiroveci pneumonia (p = 0.036) in the multivariate analysis. International prognostic index, tumor stage, smoking, previous tuberculosis, chronic obstructive pulmonary disease, and lymphoma involvement of lung parenchyma were not related to pulmonary adverse events. Patients who experienced severe pulmonary events showed shorter survival when compared to those without complications (p = 0.002). CONCLUSIONS: Our experiences with serial cases with DIIP during chemotherapy and the correlation of continuous steroid use with pulmonary infection suggest that the incidence of pulmonary complications might be high during lymphoma treatment, and careful monitoring should be performed.