Procarbazine associated alveolitis.

Abstract

Drug induced pulmonary toxicity is a well documented complication of treatment with cytotoxic agentsbleomycin, methotrexate, cyclophosphamide, and busulphan being most commonly implicated.' This report documents a severe alveolitis associated with administration of procarbazine.Case report A 44 year old man, an ex-smoker, presented with swelling in the neck, increasing fatigue, and night sweats. Supraclavicular lymph node biopsy showed lymphocyte depleted Hodgkin's disease stage IIIB, with hilar, right paratracheal, and para-aortic lymphadenopathy and splenic disease. The haematological and biochemical abnormalities were: erythrocyte sedimentation rate (ESR) 20 mm in one hour, alkaline phosphatase activity 120 IU/I (normal range 20-90 IU/l). Pulmonary function was normal except for a low Kco of 0-9 mmol min-' kPa-' 1-l (predicted normal 1.3-1-8 mmol min-' kPa-I l-l).MOPP chemotherapy was given (mustine 10 mg and vincristine 2 mg intravenously on days 1 and 8, prednisolone 40 mg'and procarbazine 150 mgdaily for 14 days). After an interval of 14 days a second course was given. There appeared to be a good clinical response after completion of the second course but the patient complained of arthralgia in the arms and knees, breathlessness on exertion, and night sweats of a week s duration. A chest radiograph showed a soft mid-zonal infiltrate. The third MOPP course, begun 14 days after the end of the second, contained reduced dosages of mustine (5 mg) and procarbazine (50 mg daily) and on this treatment these symptoms remitted. Twenty four hours after completion of the course, however, arthralgia recurred, and during the follo,wing two weeks he developed a dry cough, pains in the fingers and wrists, night sweats, and breathlessness at rest. At this time he was afebrile and had no signs of cardiac failure, but he was cyanosed and tachypnoeic and bilateral basal fine mid and late inspiratory crackles were audible. Haematological investigation showed: haemoglobin concentration 10-2 g/dl; white blood cells 2-2 x 109/l; neutropenia and eosinophilia (308/,ul figure 2.After completion of chemotherapy, restaging showed total resolution of the previous chest radiographic abnormalities and no evidence of lymphoma. 206 on 11 May 2018 by guest. Protected by copyright.

Hypersensitivity to Procarbazine and Severe RSV Pneumonia in a Child with Hodgkin’s Lymphoma

“…2 While pulmonary hypersensitivity is a well recognised toxicity of several anticancer drugs, particularly bleomycin, busulfan, methotrexate, and carmustine; procarbazine related pulmonary toxicity has been only rarely reported. 2,3,[8][9][10][11][12][13] Acute or delayed serious, even life-treating, pulmonary toxicity due to procarbazine can occur and may lead to reversible or permanent pulmonary damage. 2,3,[8][9][10][11][12][13] Delayed life threating pneumonitis due to rechallange with procarbazine in patients who initially had skin hypersensitivity reactions to procarbazine had been reported.…”

“…While these reactions are well known side effects for some certain chemotherapeutics, procarbazine related hypersensitivity reactions including fever, skin reactions, and pulmonary reactions have been reported uncommonly. [1][2][3][4][5][6][7][8][9][10][11][12][13] Procarbazine is effectively used in combination chemotherapy regimens for treatment of HL.…”

“…[9][10][11][12] We did not give him corticosteroid therapy for the management of pneumonitis because RSV was documented during a febrile neutropenic episode. In pediatric oncology patients RSV infections have been uncommonly reported.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Hypersensitivity to procarbazine is particularly uncommon during childhood. [6][7][8] Here we report on a child with Hodgkin's lymphoma (HL) who developed procarbazine induced skin hypersensitivity reactions, and then severe pneumonia due to the respiratory syncytial virus (RSV) while receiving procarbazine, and bleomycin containing chemotherapy.…”

Hypersensitivity reactions from antineoplastic agents

“…Procarbazine can also produce rare instances of pulmonary toxicity with features of Type III reactions [54][55][56][57]. These patients have interstitial pneumonitis and eosinophilia in the peripheral blood and/or lung biopsy, and they improve with procarbazine withdrawal and corticosteroid therapy.…”