Malignant Solitary Fibrous Tumor of the Pleura
Wickii T. Vigneswaran in Thoracic Surgery, 2019
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.
Pneumonitis induced by non-cytotoxic agents
Philippe Camus, Edward C Rosenow in Drug-induced and Iatrogenic Respiratory Disease, 2010
The clinical presentation of MTX-induced pneumonitis is similar whether it is used for benign or malignant diseases.5 In a review of 123 reported cases of MTX-induced pneumonitis, shortness of breath (82.1 per cent), cough (81.3 per cent) and fever (76.4 per cent) were found to be the most common presenting symptoms.34 Other manifestations included chest pain (9.8 per cent), tachypnoea (42.3 per cent) and crackles (52 per cent). Average age of presentation was 49.3 years. Out of 123 reported cases, 47 (38.2 per cent) were males and 76 (61.8 per cent) were females. In most cases the onset is subacute over several days to weeks but more acute presentations have been described.6,17,18,35,36 Bedrossian et al. also described a more chronic case with progression over several months.37 There may be a reporting bias towards more severe cases.
Lassa Fever
James H. S. Gear in CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
On examination it is noted that the conjunctivae are injected, the face tends to be flushed, the tongue is coated, and there is often marked pharyngitis associated with cervical lymph-adenopathy. The patient may then develop signs and symptoms of pneumonitis associated with pain in the chest of a pleuritic nature. Not infrequently, respiratory signs and symptoms are presenting features. There may be abdominal tenderness, often associated with diarrhea, the limb muscles are also tender. In severe cases a high fever of from 39 to 41°C persists with signs of increasing toxicity with edema of the tissues, particularly noticeable on the neck and face. This is often associated with petechial hemorrhages in the skin and sometimes bleeding from the mucous membranes into the peritoneal, pleural, and pericardial cavities. There may also be brain involvement including epileptiform convulsions. There is often increasing respiratory distress associated with the edema of the throat, pulmonary edema, and pleural effusion. Signs of myocarditis may develop followed by congestive cardiac failure.5
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).
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.
Squamous cell carcinoma of the lung: improving the detection and management of immune-related adverse events
Published in Expert Review of Anticancer Therapy, 2022
Lara Kujtan, Rama Krishna Kancha, Beth Gustafson, Lindsey Douglass, Christopher RH Ward, Blake Buzard, Janakiraman Subramanian
Generally, for IRAEs that persist after 48–72 hours of high dose corticosteroid therapy, alternative immunosuppression should be considered. Infliximab blocks the interaction of TNFɑ with IL-1 and IL-6 and has been used with success particularly in immune-related colitis[54[55]]. Vedolizumab, an integrin antagonist blocking cell adhesion molecule-1 specifically targets the GI mucosa, theoretically sparing systemic immune suppression. While vedolizumab is currently indicated for treatment of ulcerative colitis and Crohn’s disease, there are also case reports for the treatment of ICI-induced enterocolitis [56]. Mycophenolate, a common immunosuppressant in the solid organ transplant setting, suppresses B and T cell proliferation, T cell apoptosis and IL-1. Retrospective analysis and case reports describe its use in steroid-refractory IRAE mediated hepatitis, nephritis, and pancreatitis. For patients with severe ICI-induced arthritis refractory to glucocorticoids options may include infliximab, methotrexate, tocilizumab, sulfasalazine, azathioprine, and intravenous immunoglobulin. Refractory pneumonitis treatments include infliximab with or without cyclophosphamide [39].
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