A Case of Cryptogenic Organizing Pneumonia Following Azacitidine Therapy

Abstract

SESSION TITLE: Drug-induced Lung Disease SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Pulmonary toxicity due to 5-azacytidine, a deoxyribonucleic acid methyltransferase inhibitor and cytotoxic drug, has rarely been reported1. This is a report of a case of cryptogenic organizing pneumonia during the first cycle of therapy with azacitidine in a patient with myelodysplastic syndrome. CASE PRESENTATION: A 58 year old white female presented to the emergency department with a 4 hour history of fevers, chills, and malaise. Her past medical history was significant for refractory myelodysplastic syndrome with suspected transformation to acute myelogenous leukemia. Notably, she started her first cycle of Azacitidine therapy 4 days prior to admission. Her initial temperature was 101.4 degrees Farenheit and she was hypoxic to 88% on room air. Initial infectious workup, including blood and urine cultures returned negative. She underwent computed tomography of the chest which demonstrated bilateral, centrally-located ground glass and nodular opacities. She subsequently underwent bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsies. Bronchoalveolar lavage was negative for bacterial, fungal, viral or pneumocystis infection. Transbronchial lung biopsies demonstrated organizing pneumonia and immunohistochemical staining of lung tissue for CMV, adenovirus, fungus, PJP and bacteria was negative. Azacitidine was discontinued and she was started on 60 mg prednisone daily. The patient's hypoxia resolved 24 hours following initiation of prednisone and she was discharged home. She underwent successful bone marrow transplant 4 weeks later. DISCUSSION: This represents the only reported case of organizing pneumonia secondary to Azacitidine therapy in a patient who proceeded to undergo bone marrow transplant. As reported other in prior cases of Azacitidine-related organizing pneumonia, our patient experienced symptoms during her first cycle of therapy. The exact mechanism of injury is unclear but may be due to DNA hypomethylation causing direct upregulation of type I collagen synthesis in lung tissue2. CONCLUSIONS: Azacitidine-induced organizing pneumonia, if recognized early, can be treated with successful outcomes. Reference #1: Alnimer et al. Azacitidine-induced cryptogenic organizing pneumonia: a case report and review of the literature. J Med Case Rep. 2016; 10: 15. Published online 2016 Jan 20. doi:10.1186/s13256-016-0803-0 Reference #2: Misra et al. How to Diagnose Early 5-Azacytidine-Induced Pneumonitis: A Case Report. Drug Saf Case Rep. 2017 Dec; 4: 4. Published online 2017 Feb 20. doi:10.1007/s40800-017-0047-y DISCLOSURE: The following authors have nothing to disclose: Daniel Djondo, Shruti Patel No Product/Research Disclosure Information