环磷酰胺(CYC)是一种免疫抑制药物,用于治疗各种风湿性疾病的危及生命的并发症,如血管炎和系统性红斑狼疮。这种药物的一种罕见的副作用是肺炎,发生在不到1%的患者中。我们描述了一个83岁的女性,有显微镜下多血管炎的病史,在休息时出现进行性呼吸困难,在劳累时加剧,并与CYC诱导的肺炎引起的端坐呼吸相关。在这次演讲前三个月,该患者被诊断为抗中性粒细胞胞浆抗体(ANCA)阳性的低免疫新月体和坏死性肾小球肾炎,并开始接受CYC治疗.一入场,计算机断层扫描(CT)胸部显示,呈马赛克分布的双侧磨玻璃影恶化,小叶间隔和小叶间隔增厚,未出现在三个月前进行的CT上。病人接受了广泛的检查,其中包括超声心动图,支气管镜与支气管肺泡灌洗,和病毒性呼吸道面板,以排除传染病和心脏病。她开始接受抗生素和利尿剂的经验性治疗,然而,尽管有这些干预措施,她继续呼吸窘迫。一个多学科小组召集,并对CYC诱导的肺损伤进行了诊断。CYC停止了,患者开始使用泼尼松,症状明显改善。该病例强调了认识到CYC是间质性肺炎的罕见原因的重要性。当考虑CYC诱导的肺毒性时,其他病因,例如机会性感染,心脏病因,弥漫性肺泡出血,应该排除。
Cyclophosphamide (CYC) is an immunosuppressive medication used to treat life-threatening complications of various rheumatic diseases like vasculitis and systemic lupus erythematosus. A rare side effect of this medication is pneumonitis, which occurs in less than 1% of patients. We describe a case of an 83-year-old woman with a past medical history of microscopic polyangiitis, who presented with progressive dyspnea at rest, exacerbated on exertion, and associated with orthopnea that was attributed to CYC-induced pneumonitis. Three months before this presentation, the patient was diagnosed with antineutrophil cytoplasmic antibodies (ANCA)-positive pauci-immune crescentic and necrotizing glomerulonephritis and started on CYC. On admission, a computed tomography (CT) chest showed worsening bilateral ground-glass opacities in a mosaic distribution and inter and intralobular septal thickening, not present on the CT performed three months prior. The patient underwent an extensive workup, which included an echocardiogram, bronchoscopy with bronchoalveolar lavage, and viral respiratory panel to rule out infectious and cardiac pathologies. She was started on empiric treatment with antibiotics and diuretics, however, despite these interventions, she continued with respiratory distress. A multidisciplinary team convened, and the diagnosis of CYC-induced lung injury was entertained. The CYC was discontinued, and the patient was started on prednisone with significant improvement in symptoms. This case highlights the importance of recognizing CYC as a rare cause of interstitial pneumonitis. When considering CYC-induced lung toxicity, other etiologies, such as opportunistic infections, cardiac etiologies, and diffuse alveolar hemorrhage, should be ruled out.