When Treatment Takes Your Breath Away: A Rare Case of Imatinibinduced Lung Injury

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

Am J Respir Crit Care Med

Keywords

antibiotic agent, imatinib, methylprednisolone, steroid, adverse drug reaction, autoimmune vasculopathy, breathing, bronchoalveolar lavage fluid, bronchoscopy, case report, chronic obstructive lung disease, clinical article, computed tomographic angiography, conference abstract, coughing, cytology, diagnosis, drug dose, drug dose reduction, drug megadose, drug therapy, dyspnea, exercise, fever, ground glass opacity, human, hypoxemic respiratory failure, interstitial lung disease, intravenous drug administration, localized scleroderma, lung embolism, lung injury, lung lavage, male, pneumonia, side effect, special situation for pharmacovigilance, therapy, thorax deformity, vasculitis

Abstract

Imatinib is a tyrosine kinase inhibitor most often used in the treatment of hematological malignancies. There is evidence for it being used in treatment of morphea scleroderma, an inflammatory disorder that causes sclerotic changes to the skin. A 77-year-old male with history of emphysematous COPD, and morphea scleroderma on Imatinib for years, was referred to the pulmonary clinic in January 2024 for abnormal chest imaging that showed right upper and right middle lobe ground glass opacities. Over the the next few months, he developed hypoxemic respiratory failure requiring the administration of continuous supplemental oxygen. He had a repeat CT chest without contrast in August 2024 which showed worsening opacities, now bilaterally. He remained dyspneic with exertion. Due to these findings, he was scheduled for bronchoscopy with bronchoalveolar lavage (BAL) in September 2024. Following the procedure, he returned to the hospital days later with worsening dyspnea. He had CT angiography of the chest that ruled out pulmonary embolism, but again showed persistent and now worse ground glass opacities. He was started on high dose methylprednisolone, IV antibiotics, and decision was made to hold Imatinib. He had a complete autoimmune and vasculitis workup that was negative. Infectious workup from the BAL, which included fungal studies was negative. Cytology from the BAL was negative. Plasma fungal workup did not yield positive results. Over the course of ten days, his respiratory status improved significantly to the point he was taken off oxygen, despite needing it for the prior five months. The patient had repeat imaging that showed significant improvement in the ground glass opacities. Given his clinical and radiological improvement with cessation of Imatinib, addition of high dose steroids, negative autoimmune, vasculitis, and infectious workup (initiated before antibiotics given), it was felt that his clinical picture was due to Imatinib induced lung injury. There are case reports of Imatinib leading to interstitial lung disease and in other cases, pneumonitis. Patients can present with cough and fever, as well as abnormal chest imaging. Given our patient had been on Imatinib for over ten years, it was initially low on the differential for the cause of his lung injury, especially as there is no literature documenting lung injury that late into treatment. This case report emphasizes that medications can have adverse effects at any point during the treatment course and should always be considered as a possible culprit, especially if a thorough workup has been completed.

Volume

211

Issue

Supplement 1

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