Interferon α-2b
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Reactions 1086 - 28 Jan 2006 S Interferon α-2b Neurogenic pulmonary oedema?: case report A 48-year-old man, with lymph node metastases, developed neurogenic pulmonary oedema during treatment with interferon α-2b. The man, who had a history of surgical resection of a cutaneous malignant melanoma, underwent radical lymphadenectomy for lymphnode metastases and received adjuvant treatment with SC interferon α-2b at a dose of 10 MU/m 2 , three-times weekly, for 9 months. One month later, he complained of asthenia and moderate paraesthesia of his lower right limb. Approximately 30 minutes after the usual interferon α-2b injection, he presented with an erythematous eruption that was localised at the site of the puncture, with a rapid secondary generalisation; he also had dyspnoea. The pre-hospital emergency unit, found him to be comatose, (Glasgow score of 8), with oxygen desaturation at 56%, a respiratory rate of 30 breaths/min, and a systolic BP of 200mm Hg; he rapidly presented with a generalised convulsive crisis. The man was intubated and received mechanical ventilation. He quickly became hypotensive with a systolic BP of 50mm Hg; he required epinephrine [adrenaline] perfusion and fluid expansion. Chest x-rays in the ICU showed perihilar densities; this suggested pulmonary oedema. Laboratory data on admission showed leucocyte levels of 11 300 /mm 3 . Bronchoalveolar lavage fluid was inflammatory with no tumoural cells. After 48 hours, ventilatory and haemodynamic allowed weaning; but, he was slow to wake, with respiratory insufficiency and tetraparesis. Cranial CT scans showed he had a nodular lesion in the bulbar area and a nodular lesion in the frontal lobe. Extubation attempts immediately failed and he had repetition of pulmonary oedema. Palliative treatment was organised, and, on day 10, he died. Necropsy was refused by his family. Author comment: "We initially suspected [interferon α-2b] to be the cause of the shock, because of the correlation between the infection and onset of clinical signs. . . Our case is interesting because it describes a potential differential diagnostic to a drug side-effect. We assume that neurological lesions are systematically required to affirm that shock is secondary to drug." Hyvernat H, et al. Neurogenic pulmonary oedema mimicking an anaphylactic reaction to interferon alpha-2b. Clinical Oncology 17: 665, No. 8, Dec 2005 - France 801026233 1 Reactions 28 Jan 2006 No. 1086 0114-9954/10/1086-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Interferon α-2b
Reactions 1086 - 28 Jan 2006
SInterferon α-2b
Neurogenic pulmonary oedema?: case reportA 48-year-old man, with lymph node metastases, developed
neurogenic pulmonary oedema during treatment withinterferon α-2b.
The man, who had a history of surgical resection of acutaneous malignant melanoma, underwent radicallymphadenectomy for lymphnode metastases and receivedadjuvant treatment with SC interferon α-2b at a dose of10 MU/m2, three-times weekly, for 9 months. One monthlater, he complained of asthenia and moderate paraesthesia ofhis lower right limb. Approximately 30 minutes after the usualinterferon α-2b injection, he presented with an erythematouseruption that was localised at the site of the puncture, with arapid secondary generalisation; he also had dyspnoea. Thepre-hospital emergency unit, found him to be comatose,(Glasgow score of 8), with oxygen desaturation at 56%, arespiratory rate of 30 breaths/min, and a systolic BP of200mm Hg; he rapidly presented with a generalisedconvulsive crisis.
The man was intubated and received mechanical ventilation.He quickly became hypotensive with a systolic BP of50mm Hg; he required epinephrine [adrenaline] perfusion andfluid expansion. Chest x-rays in the ICU showed perihilardensities; this suggested pulmonary oedema. Laboratory dataon admission showed leucocyte levels of 11 300 /mm3.Bronchoalveolar lavage fluid was inflammatory with notumoural cells. After 48 hours, ventilatory and haemodynamicallowed weaning; but, he was slow to wake, with respiratoryinsufficiency and tetraparesis. Cranial CT scans showed he hada nodular lesion in the bulbar area and a nodular lesion in thefrontal lobe. Extubation attempts immediately failed and hehad repetition of pulmonary oedema. Palliative treatment wasorganised, and, on day 10, he died. Necropsy was refused byhis family.
Author comment: "We initially suspected [interferon α-2b]to be the cause of the shock, because of the correlationbetween the infection and onset of clinical signs. . . Our caseis interesting because it describes a potential differentialdiagnostic to a drug side-effect. We assume that neurologicallesions are systematically required to affirm that shock issecondary to drug."Hyvernat H, et al. Neurogenic pulmonary oedema mimicking an anaphylacticreaction to interferon alpha-2b. Clinical Oncology 17: 665, No. 8, Dec 2005 -France 801026233
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Reactions 28 Jan 2006 No. 10860114-9954/10/1086-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
