A 69-year-old male was diagnosed in February 2004 with stage IV extranodal marginal zone B cell lymphoma involving the mediastinal nodes, lung parenchyma and bone marrow with high LDH. Shortness of breath developed following the 5th course of Rituximab-CHOP chemotherapy (cyclophosphamide, Vincristine, Doxorubicin, Prednisolone). Bronchoscopy guided transbronchial lung biopsy revealed interstitial thickening and type II pneumocyte activation, compatible with interstitial pneumonitis. After treatment with prednisolone a complete resolution of the dyspnea was observed. The patient was well on routine follow-up at the outpatient clinic, with no progression of lymphoma or interstitial pneumonitis.
Aged ; Antibodies, Monoclonal/*adverse effects/*therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/*adverse effects/*therapeutic use ; Biopsy ; Cyclophosphamide/adverse effects/therapeutic use ; Doxorubicin/adverse effects/therapeutic use ; Humans ; Lung Diseases, Interstitial/*chemically induced/*pathology/radiography/surgery ; Lymphoma, B-Cell, Marginal Zone/*drug therapy ; Male ; Prednisone/adverse effects/therapeutic use ; Tomography, X-Ray Computed ; Vincristine/adverse effects/therapeutic use

After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.
Antiviral Agents/*adverse effects/therapeutic use ; Bronchoalveolar Lavage ; Female ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon-alpha/*adverse effects/therapeutic use ; Kidney Failure, Chronic/complications ; Lung Diseases, Interstitial/*chemically induced/pathology/radiography ; Middle Aged ; Respiratory Function Tests ; Tomography, X-Ray Computed