Acute pneumonitis consequent on pleurodesis with Viscum album extract: severe chest images but benign clinical course

Abstract

Chemical pleurodesis is widely recommended in the treatment of pulmonary air leak of different etiologies as well as malignant pleural effusions and chylothorax. Conventional chemical pleurodesis using erythromycin, tetracycline, hydrophilic fumed silica, autologous blood and talc slurry has been standardized, and its complications, including high fever, intractable chest pain, and acute lung injury, seem to be frequent. Viscum album extract is a new chemical agent for pleurodesis, and only a few studies have reported outcomes of such chemical pleurodesis in the treatment of malignant pleural effusion. Moreover, the complications resulting from pleurodesis using Viscum album extract are very rare, and acute pneumonitis has not been reported. in this paper we report the first case of acute pneumonitis after pleurodesis using Viscum album extract in a 58-year-old man who had prolonged air leaks after a left upper lingularsegmentectomy for metastatic lung cancer. We performed repeated pleurodesis four times with 2 to 4 days intervals. While the patient had no symptoms of pneumonia, such as cough, sputum, chilling, and fatigue, a follow-up chest X-ray revealed increasing peribronchial consolidations and infiltrations in the left upper lobe. A chest tomography showed extensive parenchymal consolidations and ground-glass appearances in the left lungs, representing pneumonia with acute lung injury. The acute pneumonitis was spontaneously resolved with supportive care, and the patient was discharged ten days after the development of pneumonitis. We think that pleurodesis with Viscum album extract is effective, but repeated pleurodesis should be avoided for possible onset of acute pneumonitis.

Chemical Pleurodesis Using Viscum album Extract in Gorham’s Disease Complicated with Chylothorax

“…Common complications of these agents include chest pain, tachycardia, high fever, and dyspnea. Although talc is the most effective and favored sclerosing agent, it has serious complications including acute respiratory distress syndrome, acute pneumonitis, and pulmonary edema [6]. Therefore, a number of investigations are being conducted to search for new agents for pleurodesis.…”

“…Because this was the first trial of intrapleural instillation of V. album extract in an adolescent who was refractory to management for chylothorax, the optimal dosage of V. album extract had not been established. The amount of the drug was determined bases on the dosage for prolonged pneumothorax and malignant pleural effusion in adult patients [6]. Although the usual starting dose of ABNOBA viscum F is 100 mg, which can be increased to 500 mg in adults, we used two ampules (200 mg of ABNOBA viscum F) per pleurodesis because of the patient’s lower body weight and her youth out of concern about potential side effects.…”

Acute Respiratory Distress Syndrome after Viscum album Pleurodesis for Primary Spontaneous Pneumothorax

“…Viscum alum can also serve as an effective agent for chemical pleurodesis in the treatment of congenital chylothorax and pneumothorax with continuous air leak [ 4 , 5 ]. Cho et al [ 6 ] reported a case of Viscum album -related ipsilateral acute pneumonitis after wedge resection for pneumothorax, and stated that it was self-limiting and had a benign clinical course.…”

Effect of intrapleural injection of erythromycin on congenital refractory chylothorax in the newborn

“…The principle of treatment includes the chyle drainage, respiratory support, fluid infusion and parenteral nutrition; the total effective rate of treatment is about 80 % [4]. The operative treatment can be considered in cases where there is no improvement in 2 -4 weeks, but there is a very high death risk [5]. Thus, seeking other treatments to assist with surgical treatment seems to be particularly important.…”

“…Thus, seeking other treatments to assist with surgical treatment seems to be particularly important. Studies have argued that [5,6] the intrapleural injection of anhydrous alcohol, erythromycin and growth inhibition have a good application value in decreasing the drainage volume and time and improving the cure rate. Thereby, erythromycin, widely used in the treatment of chylothorax, promotes inflammation on the surface of the pleural serous membrane [7].…”