Paclitaxel Associated Lung Toxicity in a Patient with Invasive Urothelial Carcinoma

Paclitaxel is an anti-cancer drug that induces mitotic arrest via microtubule hyperstabilization, but which also causes side effects due to its hydrophobicity and cellular promiscuity. A 71-year-old male patient presented at the polyclinic with dyspnea present for 2 weeks. In November 2016, the patient had been diagnosed with bladder-derived invasive urothelial bladder carcinoma and received 2 cycles of paclitaxel therapy. High-resolution computed tomography revealed peripheral-subpleural interlobular septal thickening, reticular densities, ground-glass density areas, and peripheral focal consolidation in both lungs, particularly on the right. Peripheral traction bronchiectasis was also observed, especially in the posterobasal segments of both lower lobes. Bronchial lavage revealed hyperplastic reserve cells, macrophages, bacterial clusters, and polymorphonuclear leukocytes, but no atypical cell were observed. The infection was ruled out. Chemotherapy was terminated and methylprednisolone (0.75 mg/kg) was initiated. Regression was observed in a control posteroanterior chest graphy after 1 month of steroid therapy. This case was presented because lung toxicity due to paclitaxel is rare.

Ýnvazif Ürotelyal Karsinomlu Hastada Paklitaksel’e Baðlý Akciðer Toksisitesi

Paklitaksel, mikrotübül hiperstabilizasyon yoluyla mitotik duraklamayý baþlatan bir anti-kanser ilacý olup hidrofobikliði ve hücresel seçiciliði olmamasý nedeniyle yan etkilere neden olmaktadýr. Yetmiþ bir yaþýnda erkek hasta göðüs hastalýklarý polikliniðine 2 haftadýr olan nefes darlýðý þikâyeti ile baþvurdu. Kasým 2016 ‘da mesane kaynaklý invazif ürotelyal mesane karsinom tanýsý alan hasta 2 kür Paklitaksel tedavisi almýþtý. Hastanýn posteroanterior akciðer grafisinde bilateral periferik infiltrasyonlarý mevcuttu. Yüksek Rezolüsyonlu Bilgisayarlý Tomografide her iki akciðerde saðda daha belirgin olmak üzere periferal-subplevral interlobüler septal kalýnlaþmalar, retiküler dansiteler, buzlu cam yoðunluk alanlarý, periferal yamasal fokal konsolide alanlar izlendi. Özellikle her iki alt lob posterobazal segmentlerde periferal yerleþimli traksiyon bronþektaziler izlendi. Bronþ lavajýnda; hiperplastik rezerv hücreler, makrofajlar, bakteri kümeleri, PNL izlendi, atipik hücre gözlenmedi. Hastada mevcut bulgularla Paklitaksel toksisitesi düþünüldü, kemoterapisi sonlandýrýldý ve metilprednizolon tedavisi baþlandý. Metilprednizolon tedavisinin birinci ayýnda kontrol akciðer grafisinde regresyon izlendi. Paklitaksel’e baðlý akciðer toksisitesisinin nadir görülmesi nedeniyle bu olguyu sunduk.

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