A Case of Drug-Induced Interstitial Lung Disease Caused by Epirubicin and Cyclophosphamide Therapy Before Breast Cancer Surgery

Abstract

We report a case of drug-induced interstitial lung disease (ILD) caused by epirubicin and cyclophosphamide (EC) therapy in a patient with breast cancer. The patient suffered from a dry cough, fever, and exertional dyspnea after two courses of EC therapy. Antibiotic treatment did not improve her symptoms. Chest CT images revealed diffuse, ground-glass opacities and mild interlobular septal thickening in both lungs, a pattern suggesting a hypersensitivity pneumonitis. Bronchoalveolar lavage fluid analysis revealed lymphocytosis with no evidence of infection nor malignancy. Corticosteroid therapy was initiated, which led to a rapid resolution of ILD. To date, there has been only one case report regarding drug-induced ILD caused by EC therapy. This case report could increase awareness of chemotherapy-induced pneumonitis.

Anti-EJ antibody-positive interstitial pneumonia with breast cancer improved by combining immunosuppressive therapy and chemotherapy

“…Since cyclophosphamide is sometimes used for IP treatment in concert with corticosteroids [ 18 ], it can serve dual purposes: addressing breast cancer and managing IP effectively. However, there is documentation of ASSD exacerbation following docetaxel, cyclophosphamide, and trastuzumab treatment [ 4 ], along with EC therapy-induced IP [ 20 , 21 ]. Efficacy and safety of chemotherapy regimens like cyclophosphamide for patients with coexisting malignancies and IP warrant further exploration.…”