Combined chemotherapeutic regimens in conjunction with
oxaliplatin are considered safe and effective treatment options in the clinical management of metastatic
colorectal cancer. A 62-year-old male patient with a metastatic rectal
carcinoma developed a pulmonary reaction after the first application of the combined standard
chemotherapy regimen (
5-fluorouracil and
sodium folinic acid as a 24 h infusion and
oxaliplatin). Following the first dose of
chemotherapy, the patient developed acute dyspnoea and
fever. A computerised scan of the chest revealed bilateral pulmonary patchy consolidation. Despite high-dose empiric
antibiotic and antimycotic treatment, no clinical improvement was seen. The patient's condition deteriorated, and he required invasive
mechanical ventilation. Diagnostic thoracoscopic wedge resections were performed for further diagnosis. The histological workup revealed distinct granulomatous
inflammation, but no microbial pathogens were to be found. Thereupon, a drug-induced reaction to
chemotherapy was suspected and high-dose
steroid treatment initiated. Subsequently, the patient's respiratory condition improved and he was extubated. The present case exemplifies the rare course of a bilateral
pneumonia-like, drug-induced granulomatous reaction following a single application of
oxaliplatin. In addition to the known side effects of
oxaliplatin-containing
combination chemotherapy, unexpected serious adverse events in the form of pulmonary toxicities should also be taken into account.