Sequential adjuvant chemoradiotherapy-induced diffuse alveolar haemorrhage in a patient with breast cancer successfully treated with corticosteroid plus recombinant human soluble thrombomodulin

Abstract

The effective treatment for corticosteroid (CS)-refractory sequential chemoradiotherapy (CRT)-induced lung injury has not been established. We report a case of sequential CRT-induced diffuse alveolar haemorrhage (DAH) successfully treated with CS therapy plus recombinant human soluble thrombomodulin (rhTM). A 69-year-old woman was treated with sequential adjuvant CRT for early-stage breast cancer. After sequential CRT, she suffered from progressive dyspnoea. Chest CT scan showed consolidations in the irradiation field and diffuse ground-glass attenuations in the non-irradiation regions. We suspected sequential CRT-induced DAH because of increased haemosiderin-laden macrophages in bronchoalveolar lavage fluid. Her clinical conditions did not improve with high-dose CS therapy. Therefore, rhTM was added, and her disease and serum high-mobility group box-1 levels improved rapidly. Therefore, rhTM plus CS might be a safe and effective treatment for sequential CRT-induced lung injury, although further study is necessary to validate these findings.

Vasculitis and Breast Cancer: Mind the Hint

“…The development of DAH caused by sequential adjuvant chemoradiotherapy for BC was also described in a female patient with BC (an adenocarcinoma of the left breast, pT1cN0M0) originally treated with conserving surgery and subsequently with adjuvant radiotherapy and chemotherapy. The symptoms related with the evolving DAH appeared 9 days after the third administration of docetaxel and cyclophosphamide (3 months after the final irradiation) [5].…”

Pneumonitis Due to <i>Oren-gedoku-to</i> (Coptis Detoxifying Decoction)

“…Ougon is suspected to cause JHM-induced pneumonitis in many cases, and we found that 27 JHMs produced by Tsumura contained ougon . The results of a DLST using peripheral blood were positive for ougon , although the sensitivity of the DLST was not enough to detect drug-induced pneumonitis (9). In addition, the activity of each crude drug may change after being mixed with other drugs.…”