No abstract

INTRODUCTION:Oxaliplatin is a third generation platinum derivative alkylating agent. The platinum compound binds to the DNA forming crosslink which inhibits DNA replication and transcription, resulting in cell death. It is a nonspecific cell cycle cytotoxic agent. Common side effects are peripheral neuropathy, and induced hypersensitivity [1].CASE PRESENTATION: 65-year-old Caucasian male with past medical history of chronic obstructive pulmonary disease not on home oxygen, former tobacco smoker and alcohol user presents to the emergency department for worsening dyspnea for three weeks. He recently completed 6 cycles of 5 Fluorouracil and Oxaliplatin for Stage IIIA Sigmoid Adenocarcinoma. Patient denies use of recreational drugs. Earlier that day he was at the pulmonary clinic and ambulatory oxygen measurement showed saturation of 60% on room air. High dose steriods were initiated, the patient continued to require high flow nasal cannula and then was on noninvasive positive pressure ventilation. He was subsequently intubated and his course was complicated by a left pneumothorax requiring a chest tube. He was not a candidate for a lung transplant and was placed on comfort care and expired shortly thereafter. Review of system: positive for cough, white phlegm, chills for three days. Physical Exam: afebrile, heart rate 108, respiration 30-34, blood pressure 142/91, oxygen saturation 89% on high flow nasal cannula of 40 liters per minute, and fraction of inspired oxygen of 100%. He appeared acutely ill, unable to complete full sentences, alert and oriented x4. Lungs had bilateral crackles and expiratory wheezes.

Shrinking Lung Syndrome (SLS) is an uncommon complication of systemic lupus erythematosus (SLE). SLS is a diagnosis of exclusion with features of dyspnea ruled out by other causes using imaging and diagnostic studies, pleuritic chest pain, and elevated diaphragm. Currently, there are many theories of the etiology; however, there is no clear pathogenesis, conclusive treatment, and preventative measures. We report a case of a 41-year-old woman with SLE admitted for pleuritic chest pain with unclear cause of shortness of breath. After CTA chest study, laboratory, chest x-ray, and pulmonary function test we were able to appropriately diagnose her with SLS and treat her with steroids as per limited current research guidelines.