Pemetrexed-induced typhlitis in non-small cell lung cancer

Pemetrexed is U.S. Food and Drug Administration-approved as a second line, single-agent treatment of recurrent metastatic non-small cell lung cancer. Gastrointestinal side effects, including stomatitis, diarrhea, and vomiting are reported to be less than 1% and rarely severe. In the premetrexed clinical trial database of 1327 patients, various types of colitis were reported by a total of nine patients (0.6%). Typhilitis is a gastrointestinal complication of chemotherapy, which presents as fever and abdominal pain. The diagnosis is supported by the findings of bowel wall thickening on computed tomographic imaging. Typhilitis is usually seen in the setting of severe chemotherapy-induced neutropenia for acute leukemia. Nevertheless, it is increasingly recognized as a complication of therapy in solid tumors. We present the first documented case of typhilitis after treatment with pemetrexed and successful therapy with supportive treatment.