You take an elective in outpatient oncology. Your preceptor specializes in the treatment of squamous cell head and neck cancers, squamous cell cervical cancer, squamous cell esophageal cancer, germ cell tumors, and Hodgkin and non-Hodgkin lymphoma. This is an eclectic collection of cancers, but they can all be treated with the drug shown above. You note that some of the older patients, especially those who receive large doses, have renal impairment, or get radiation develop nonproductive cough, dyspnea, and pleuritic or substernal chest pain. This usually happens 1-6 months after starting chemotherapy. Other symptoms include fever, tachypnea, rales, lung restriction, and hypoxemia. A sputum analysis is negative for infection.Unfortunately, I could not find a good image of this disease, but the "classic pattern" is bibasilar subpleural opacification with volume loss and blunting of the costophrenic angles. Eventually, there may be consolidation and honeycombing.
Challenge: What is the drug, and what is the diagnosis?
Image shown under GNU Free Documentation License.
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Verticillus
This is bleomycin-induced lung injury. Bleomycin is a chemotherapeutic agent isolated from a strain of Streptomyces verticillus in 1966. However, it can cause interstitial pulmonary fibrosis (or fibrosing alveolitis). The mechanism or pathogenesis is unclear. The DDX include lung infection, metastases, and radiation-induced pulmonary fibrosis.
Sources: UpToDate; Wikipedia.
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