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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Aspiration into the lung of stomach contents occurs most often during or immediately after labor. The combination of delayed gastric emptying, a relaxed lower esophageal sphincter, and increased intra-abdominal pressure with recumbency and sedation or analgesia increase the risk of vomiting and aspiration. Acutely, aspiration can lead to a chemical pneumonitis or bronchospasm, and aspiration of upper airway organisms such as anaerobes and streptococci can ultimately lead to a bacterial pneumonia. Chemical pneumonitis, while hard to distinguish from pneumonia, generally has an acute onset with dyspnea, cough, and low-grade fever. Radiographs reveal multifocal infiltrates with basilar predominance and treatment is supportive. Bronchospasm can be indistinguishable from asthma with dyspnea and wheezing and is treated with bronchodilators (91,92).
Antibody-Based Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
The most common side effects are GI symptoms (e.g., nausea, vomiting, constipation, diarrhea), fatigue, alopecia, decreased appetite, anemia, decreased neutropenia, leukopenia, and decreased platelet count. Interstitial lung disease and pneumonitis, including cases resulting in death, have also been reported.
Malignant Solitary Fibrous Tumor of the Pleura
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Amber Redmond, Eric P. Anderson, Christopher W. Seder, Nicole M. Geissen
The presentation, clinical features, clinical outcomes, and treatment of SFTs have largely been derived from case reports and retrospective studies. While our patient presented with vague symptoms of progressive shoulder pain, symptoms at the time of diagnosis of pleural SFTs are variable. Approximately 40%–60% of patients present with symptoms including cough, shortness of breath, or chest pain, with rare instances of hemoptysis or obstructive pneumonitis. SFTs may be associated with immune-mediated syndromes such as Bierre-Marie-Bamberger syndrome (hypertrophic pulmonary osteoarthropathy) and Doege–Potter syndrome (non-islet cell tumor hypoglycemia). The majority of pleural SFTs arise from the visceral pleura and have a pedicled stalk containing the vasculature. Parietal pleural-based tumors tend to have a broad-based sessile attachment.
Approaches for development of LAG-3 inhibitors and the promise they hold as anticancer agents
Published in Expert Opinion on Drug Discovery, 2022
Martin Perez-Santos, Maricruz Anaya-Ruiz, Luis Villafaña-Diaz, Gabriela Sánchez Esgua
Treatment-related adverse events observed in at least 10% of patients were pruritus, fatigue, rash, hypothyroidism, diarrhea, and vitiligo. Treatment with antibodies can lead to immune-mediated adverse reactions, including pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, and myocarditis, among others. 3.7% of treated patients developed pneumonitis, which was resolved in 85% with corticosteroid treatment. Colitis occurred in 7% of treated patients and resolved in 83% with corticosteroid treatment. Hepatitis was found in 6% of the treated patients, which resulted in 70% after of corticosteroid treatment. Adrenal insufficiency occurred in 4% of patients, where 87% were treated with hormone replacement therapy and corticosteroids. Thyroiditis was present in 2.8% of treated patients, which resulted in 90% after corticosteroid treatment. Nephritis and renal dysfunction were observed in 2% of patients, which resolved in 71% with corticosteroid treatment. Dermatitis occurred in 9% of patients, resulting in 70% after corticosteroid treatment. Myocarditis was present in 1.7% of patients and was 100% resolved after treatment with corticosteroids.
Overview of checkpoint inhibitor pneumonitis: incidence and associated risk factors
Published in Expert Opinion on Drug Safety, 2021
Yuji Shibata, Shuji Murakami, Terufumi Kato
It is difficult for clinicians to determine whether pneumonitis is caused by radiation therapy or an ICI. Some important points must be considered to identify the cause of pneumonitis in patients receiving ICI treatment with previous chemoradiotherapy. First, radiation pneumonitis occurs in the radioactive field and CIP tends to occur nonsegmentally in both lung fields and especially outside the regions of high-dose chest radiation [87]. Second, radiation pneumonitis typically occurs within 2–4 months after the end of radiation therapy, whereas the onset of CIP has not been clarified [88]. Suresh et al. reported that the median time of CIP onset was 82 days after immunotherapy, which is similar to that of radiation pneumonitis [40]. The radiological features that differentiate the cause of pneumonitis are described in the following section.
Anti-PD-1-Related Exacerbation of Interstitial Lung Disease in a Patient with Non-Small Cell Lung Cancer: A Case Presentation and Review of the Literature
Published in Cancer Investigation, 2020
Julie Anne L. Gemmill, Amna Sher
Use of ICI in patients with pre-existing ILD should be made on a case-by-case basis after careful consideration and discussion of risks and benefits with the patient. Patients must be closely monitored for signs and symptoms of pneumonitis including new onset cough, shortness of breath, dyspnea on exertion, and hypoxia. Symptomatic patients should be evaluated with radiographic CT imaging and cultures. Once pneumonitis has been confirmed, symptoms should be graded in severity from 1 to 5 using the CTCAE v5.0 (20). Patients with Grade 2 pneumonitis should have immunotherapy withheld and be started on corticosteroids at an initial dose of 1–2 mg/kg/day prednisone or 0.5–1 mg/kg/day methylprednisolone followed by taper. Pembrolizumab may be resumed in patients with complete or partial resolution (Grade 0–1) after corticosteroid taper. In moderate to severe cases, bronchoscopy may be considered to exclude infectious sources prior to starting immunosuppression. In severe cases, higher doses of corticosteroids may be warranted (i.e., methylprednisolone 2–4 mg/kg/day) and additional therapy with mycophenolate mofetil, cyclophosphamide and infliximab can be considered (21). Patients with Grade 3–4 or recurrent Grade 2 pneumonitis should have pembrolizumab permanently discontinued (9).