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Interstitial pneumonitis probably induced by cyclophosphamide in nephrosis
H Harigaya1, K Matsubara, H Nigami
1Department of Pediatrics, Nishi-Kobe Medical Center, Japan.
Acta Paediatrica Japonica : Overseas Edition
|June 1, 1997
Summary
Cyclophosphamide therapy for nephrotic syndrome can cause rare but serious lung disease. Early detection and drug withdrawal are crucial for patient recovery and preventing fatal outcomes.
Area of Science:
- Pediatric Nephrology
- Pulmonology
- Clinical Pharmacology
Background:
- Steroid-resistant nephrotic syndrome (SRNS) in children often requires alternative immunosuppressive agents.
- Oral cyclophosphamide is a recognized treatment for SRNS, but potential toxicities require monitoring.
Observation:
- A 32-month-old girl with SRNS developed fever, cough, and cyanosis after initiating oral cyclophosphamide.
- Radiographic findings revealed diffuse ground-glass opacities, suggestive of interstitial pneumonitis.
- Pulmonary symptoms worsened despite antimicrobial therapy.
Findings:
- Discontinuation of cyclophosphamide and high-dose methylprednisolone treatment led to significant clinical improvement.
- The clinical presentation and response to treatment strongly suggest cyclophosphamide-induced interstitial pneumonitis.
- This adverse pulmonary event occurred even with a low dose of oral cyclophosphamide.
Implications:
- Cyclophosphamide can induce potentially fatal interstitial pneumonitis in pediatric patients.
- Clinicians should maintain a high index of suspicion for this rare complication.
- Prompt recognition and withdrawal of cyclophosphamide are critical for managing this adverse effect.