利妥昔单抗联合化疗致间质性肺炎

Interstitial pneumonia induced by rituximab combined with chemotherapy

1例62岁男性B细胞非霍奇金淋巴瘤患者接受利妥昔单抗联合环磷酰胺、表柔比星、长春新碱、泼尼松方案治疗,治疗前胸部CT检查未见异常。第2个周期给药结束后1周,患者出现咳嗽、胸闷、运动后气喘等症状,当地医院考虑肺部炎症,给予拉氧头孢治疗。但患者症状逐渐加重,1周后出现呼吸困难、不能站立,遂转入解放军联勤保障部队第九〇〇医院。胸部CT检查示双肺多发斑片状影及网络样改变,诊断为间质性肺炎,考虑为利妥昔单抗联合化疗所致。给予注射用甲泼尼龙琥珀酸钠和注射用头孢哌酮钠舒巴坦钠治疗。1d后患者呼吸困难、胸闷症状明显缓解;4d后咳嗽、气喘症状明显好转;17d后复查胸部CT,双肺病变有所好转。

A 62-year-old male patient with B cell non-Hodgkin's lymphoma received chemotherapy of rituximab combined with cyclophosphamide,epirubicin,vincristine,and prednisone.No abnormality in the chest CT examination was found before treatments.One week after finishing the second cycle of chemotherapy,the patient developed cough,chest distress,and asthma after exercise,and etc.Lung inflammation was considered and moxalactam was given.However,the patient's symptoms gradually worsened.One week later,he had difficulty breathing and could not stand.Then he was transferred to the 900th Hospital of the Chinese People's Liberation Army Joint Service.The chest CT examination showed multiple patchy and network-like changes in bilateral lungs.Interstitial pneumonia was diagnosed,which was considered to be caused by rituximab combined with chemotherapy.Methylprednisolone sodium succinate and cefoperazone sodium and sulbactam sodium were given.One day later,dyspnea and chest tightness relieved obviously;4 days later,cough and asthma improved significantly;17 days later,the chest CT reexamination showed that the lesions in bilateral lungs improved.