alexa Pirfenidone for Bleomycin Induced Lung Toxicity | Open Access Journals
ISSN: 2161-105X
Journal of Pulmonary & Respiratory Medicine
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Pirfenidone for Bleomycin Induced Lung Toxicity

Suliman Alamro1,*, Anna Selvaggio1, Paul Noble2 and Zhou Zhang1
1Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
2Department of Medicine, Women’s Guild Lung Institute, Cedars-Sinai Medical Center, USA
Corresponding Author : Suliman Alamro
Division of Pulmonary and Critical Care Medicine
Cedars-Sinai Medical Center
8700 Beverly Blvd, Los Angeles
CA 90048, USA
Tel: 202-569-7840
E-mail: [email protected]
Received December 14, 2015; Accepted January 20, 2016; Published January 25, 2016
Citation: Alamro S, Selvaggio A, Noble P, Zhang Z (2016) Pirfenidone for Bleomycin Induced Lung Toxicity. J Pulm Respir Med 6:317. doi:10.4172/2161-105X.1000317
Copyright: © 2016 Alamro S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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64 years old male with hodgkins lymphoma was receiving chemotherapy containing bleomycin developed cough and dyspnea after his 8th cycle. He underwent a comprehensive evaluation including PFTs which showed His FVC was 72% of predicted, TLC 83% and DLCO 52% and no desaturation on ambulation. Chest CT showed peripheral reticular opacities with some area of consolidation but also honeycombing involving the lower lung zones greater that the upper lung zones. He was initially started on prednisone at 80 mg daily in addition to gleevec with symptomatic improvement. However, his symptoms recurred after a trip to San Antonio and he was admitted to the hospital where CTA showed a Diffuse and severe interstitial fibrosis and alveolitis most consistent with bleomycin toxicity in an addition to left lower lobe pulmonary embolus. A transbronchial biopsy revealed patchy organizing pneumonia and intra alveolar macrophages (Figure 1). The patient was treated with high dose steroids in addition to anti-coagulation for his PE where his symptoms improved and was discharged. On a subsequent follow up, his PFTs showed an FVC 55%, TLC of 62% and DLCO of 27%. Repeat chest CT showed a UIP pattern. The decision was made to start him on perfinedone. He had significant improvement in his symptoms and his repeat PFT after three months of therapy showed an FVC OF 69%, TLC 76% and a DLCO of 43%. He was able to walk 393 meters with no desaturation. He was weaned off steroids and after 6 months of therapy his PFTs showed normal lung volumes with a DLCO of 48% (Figure 2).


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