Interstitial Pneumonitis during Imatinib Therapy in a Patient with Gastrointestinal Stromal Tumor: A Case Report

Abstract

Introduction: Imatinib is approved for the treatment of chronic myeloid leukemia and for gastro intestinal stromal tumors. It is generally well tolerated with mild common toxicities such as diarrhea, fatigue, skin rash and edema, however pulmonary complications are uncommon. Case presentation: In May 2013, a Moroccan 81-year-old man without medical history underwent an emergency wedge resection of the stomach for severe hematemesis with hemodynamic instability. The pathology report showed a gastric gastro intestinal stromal tumor. In July 2013, Imatinib 400 mg per day was started, the patient showed good tolerance to the drug, although mild diarrhea was present. After 16 months, the patient showed a sudden alteration of his performance status, dyspnea, productive cough and fever. Chest X-rays and computed tomography revealed a left pulmonary interstitial syndrome with bilateral pleural effusions. As these findings were highly suggestive of Imatinib-induced interstitial pneumonitis, Imatinib was discontinued. In the meantime, the patient was given oral prednisone: 60mg daily for 10 days. Under the corticosteroid therapy, his symptoms and radiological findings were resolved. The patient comes in regularly for symptomatic control without any signs of tumor’s relapse. Conclusion: Physicians should consider the possibility of Imatinib-induced pulmonary toxicities when patients develop respiratory symptoms or abnormal radiologic features during Imatinib treatment. The usual treatment is to discontinue the drug, and administer corticosteroids.