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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
PubMed

Insights

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.
Keywords:
azacitidinedrug-induced lung injurymyelodysplastic syndromeorganizing pneumoniasteroids

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