Novel tumor necrosis factor toxic effects. Pulmonary hemorrhage and severe hepatic dysfunction

Recombinant human tumor necrosis factor is an investigational antitumor agent currently undergoing clinical trials. Previous reports of pulmonary and hepatic toxicities include mild reversible decline in pulmonary diffusing capacity and mild elevation of bilirubin and transaminases. This report describes two novel toxicities in patients receiving their first intravenous dose of tumor necrosis factor: pulmonary hemorrhage and severe hepatic dysfunction. These patients received no other antitumor therapy for at least 4 weeks before tumor necrosis factor treatment and no additional antitumor therapy concomitant with tumor necrosis factor. An analysis of the possible pathogenesis is presented.