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Drug-induced Lung Injury Caused by Azacitidine That Was Not Treated with Drugs
Hikaru Mamizu1, Morihiro Kumagai1, Chika Kuwana1
1Department of Internal Medicine, Niigata Prefectural Central Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|June 26, 2025
Summary
This study highlights azacitidine-induced lung injury, a form of organizing pneumonia (OP), in myelodysplastic syndrome patients. Early recognition and discontinuation of azacitidine can lead to recovery without steroids.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Azacitidine is a hypomethylating agent used in the treatment of MDS.
- Drug-induced lung injury (DILI) is a potential adverse effect of various medications, including chemotherapy agents.
Purpose of the Study:
- To report a case of organizing pneumonia (OP) secondary to azacitidine treatment in a patient with myelodysplastic syndrome.
- To investigate the clinical presentation and management of azacitidine-induced lung injury.
- To discuss the implications for steroid therapy in azacitidine-induced lung injury.
Main Methods:
- A case report of an 83-year-old male patient with MDS receiving azacitidine.
- Clinical assessment, bronchoscopy with biopsy, and histopathological examination.
- Monitoring of patient's response to discontinuation of azacitidine and antimicrobial therapy.
Main Results:
- The patient developed worsening pneumonia despite antimicrobial treatment.
- Bronchoscopy revealed organizing pneumonia (OP), presumed to be drug-induced lung injury from azacitidine.
- Discontinuation of azacitidine led to gradual improvement of pneumonia without the need for steroid therapy.
Conclusions:
- Azacitidine can cause drug-induced lung injury presenting as organizing pneumonia, often with minimal subjective symptoms.
- Discontinuation of azacitidine is crucial for managing this condition.
- While steroid therapy may not be necessary for early-stage azacitidine-induced OP, progression to acute interstitial pneumonia or continued azacitidine use may lead to steroid resistance.
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