LENALIDOMIDE-INDUCED ACUTE EOSINOPHILIC PNEUMONIA

Abstract

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: MDS/MPD (Myelodysplastic Syndrome/Myeloproliferative disorder) overlap syndrome is characterized by dysplasia and cytopenias which prevalence is not known. Lenalidomide is an immunomodulatory drug analogous to thalidomide that is frequently used in myelodysplastic syndrome and also used in cases of Polycythemia Vera. Pulmonary side effects are rare. We present a case of lenalidomide induced acute eosinophilic pneumonia. CASE PRESENTATION: A 76-year-old male with a history of MDS/MPD overlap syndrome, primary and secondary hemochromatosis (transfusion dependent) who recently started lenalidomide was admitted for shortness of breath. He had 2 days of respiratory distress, desaturation (83% room air), new onset of cough and nasal congestion. No history of fever, chills, chest pain, palpitations, no sick contacts. He had chronic fatigue but not worse than baseline. The physical exam was positive for a respiratory distress, a flow systolic murmur and rales at the pulmonary bases. Work up included a negative procalcitonin, negative respiratory viral panel, negative blood cultures. Chest x-ray showed diffuse hazy interstitial and airspace opacity. Chest CT showed ground glass pulmonary infiltrates. His initial management included blood transfusions, diuretics, broad spectrum antibiotics and coverage for PCP and atypical pneumonia, oxygen by nasal canula with 2 Litters. Diuretics were given for suspected pulmonary edema. His Echo showed an ejection fraction of 60-65% and despite effective diuresis, symptoms did not improve. Patient underwent a bronchoalveolar lavage which showed 27% eosinophils, negative gram stain, negative bacterial and fungal cultures. Cytology was negative for malignancy. PCP DFA was negative. A new diagnosis of acute eosinophilic pneumonia was made and patient was treated with steroids and lenalidomide was stopped as well as antibiotics. DISCUSSION: Lenalidomide is becoming a frequently used medication in the last few years due to its new multiple uses approved by the FDA. Pulmonary side effects are rare and acute eosinophilic pneumonia is added to this list. The Naranjo Drug Adverse Drug Reaction Probability Scale was positive for 8 points in our case, making it a probable drug reaction. This is the first case to our knowledge ever reported in MDS/MPD treatment with Lenalidomide. CONCLUSIONS: Lenalidomide is a pharmacologic agent that is linked to multiple but rare pulmonary side effects. Providers should be aware that acute eosinophilic pneumonia can be one of this rare side effects. Reference #1: Toma, Andrew & P. Rapoport, Aaron & Burke, Allen & Sachdeva, Ashutosh. (2017). Lenalidomide-induced eosinophilic pneumonia: Lenalidomide and eosinophilic pneumonia. Respirology Case Reports. 5. e00233. 10.1002/rcr2.233 Reference #2: Mankikian J, Lioger B, Diot E, et al. 2014. Pulmonary toxicity associated with the use of lenalidomide: case report of late-onset acute respiratory distress syndrome and literature review. Heart Lung 43(2):120–123. Reference #3: Naranjo CA, Busto U, Sellers EM, et al. 1981. A method for estimating the probability of adverse drug reactions. Clin. Pharmacol. Ther. 30(2):239–245. DISCLOSURES: No relevant relationships by Mohamad Bitar, source=Web Response No relevant relationships by Fernando Fuentes, source=Web Response No relevant relationships by Shahla Mallick, source=Web Response