Statins lower the hyperlipidemia and reduce the incidence of cardiovascular events and related mortality. A 60-year-old man who was diagnosed with a transient ischemic attack was started on acetyl-L-carnitine, cilostazol, and rosuvastatin. After rosuvastatin treatment for 4 weeks, the patient presented with sudden onset fever, cough, and dyspnea. His symptoms were aggravated despite empirical antibiotic treatment. All infectious pathogens were excluded based on results of culture and polymerase chain reaction of the bronchoscopic wash specimens. Chest radiography showed diffuse ground-glass opacities in both lungs, along with several subpleural ground-glass opacity nodules; and a foamy alveolar macrophage appearance was confirmed on bronchoalveolar lavage. We suspected rosuvastatin-induced lung injury, discontinued rosuvastatin and initiated prednisolone 1 mg/kg tapered over 2weeks. After initiating steroid therapy, his symptoms and radiologic findings significantly improved. We suggest that clinicians should be aware of the potential for rosuvastatin-induced lung injury.
Acetylcarnitine ; Bronchoalveolar Lavage ; Chemically-Induced Disorders ; Cough ; Dyspnea ; Fever ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperlipidemias ; Incidence ; Ischemic Attack, Transient ; Lung ; Lung Diseases, Interstitial* ; Lung Injury ; Macrophages, Alveolar ; Middle Aged ; Mortality ; Polymerase Chain Reaction ; Prednisolone ; Radiography ; Thorax ; Rosuvastatin Calcium

BACKGROUND/AIMS: The aim of our study was to determine the incidence and clinical features of severe pulmonary complications in patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) as the initial treatment for lymphoma. METHODS: A retrospective analysis of pulmonary infection and drug-induced interstitial pneumonitis (DIIP) was performed using lymphoma registry data. R-CHOP was administered in 71 patients and CHOP in 29 patients. RESULTS: The severe pulmonary adverse events tended to occur more frequently with R-CHOP (18.3%) than CHOP alone (13.8%), although the difference was not significant (p = 0.771). DIIP occurred in five patients in the R-CHOP arm (7%) and in one in the CHOP arm (3%). The continuous use of steroids for conditions other than lymphoma significantly increased the risk of pulmonary infection including Pneumocystis jiroveci pneumonia (p = 0.036) in the multivariate analysis. International prognostic index, tumor stage, smoking, previous tuberculosis, chronic obstructive pulmonary disease, and lymphoma involvement of lung parenchyma were not related to pulmonary adverse events. Patients who experienced severe pulmonary events showed shorter survival when compared to those without complications (p = 0.002). CONCLUSIONS: Our experiences with serial cases with DIIP during chemotherapy and the correlation of continuous steroid use with pulmonary infection suggest that the incidence of pulmonary complications might be high during lymphoma treatment, and careful monitoring should be performed.
Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/administration & dosage/*adverse effects ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects ; Cyclophosphamide/administration & dosage/adverse effects ; Doxorubicin/administration & dosage/adverse effects ; Female ; Humans ; Incidence ; Lung Diseases, Interstitial/*chemically induced/mortality ; Lymphoma, Non-Hodgkin/*drug therapy/mortality ; Male ; Middle Aged ; Pneumocystis jirovecii ; Pneumonia, Bacterial/mortality ; Pneumonia, Pneumocystis/mortality ; Prednisone/administration & dosage/adverse effects ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Tuberculosis, Pulmonary/mortality ; Vincristine/administration & dosage/adverse effects ; Young Adult