The Journal of the Japanese Respiratory Society ONLINE JOURNAL
ABSTRACT
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Article in Japanese
Case Report
The value of transbronchial lung biopsy findings in the diagnosis of a case of TS-1-induced pulmonary toxicity
Shunsuke Ito1), Tomoyoshi Yamaguchi1), Ryo Morisue1), Yukari Ogawa1), Kazuo Munakata1) and Yuh Fukuda2)
1)Department of Internal Medicine, Nippon Medical School, Musashikosugi Hospital
2)Department of Analytic Human Pathology, Nippon Medical School
ABSTRACT
We report the case of a 67-year-old man with a diagnosis of stage IV stomach cancer in May 2010 who was treated with outpatient chemotherapy using TS-1, paclitaxel and lentinan. Dyspnea and coughing developed after drug administration in November and the patient was hospitalized on day 5 after the appearance of symptoms due to hypoxemia and the presence of ground-glass opacities in the right middle and lower lung fields. On the same day, bronchoscopy was performed for differentiation from infection and lymphangitic carcinomatosis. A transbronchial lung biopsy suggested drug-induced pulmonary toxicity, and a drug lymphocyte stimulation test was highly positive for TS-1. Discontinuation of TS-1 alone improved his respiratory status and imaging findings. TS-1 is available only in Japan, and because it is administered orally and its toxicity is minimal, its use has been expanded to treat a variety of malignancies. Drug-induced pulmonary toxicity due to TS-1 occurs in only 0.03% of all cases, and there are few reports regarding the histopathological findings of TS-1-related pulmonary toxicity. Although it can be difficult to diagnose drug-induced pulmonary toxicity because it demonstrates a variety of imaging findings, the present case suggests that it is important to proactively perform transbronchial lung biopsy at the early stage of diagnosis and promptly determine a course of treatment.
KEYWORDS: TS-1, Drug-induced pulmonary toxicity, Transbronchial lung biopsy
RECEIVED: 2011.4.25
JJRS, 49(12): 949-954, 2011
