CASE PRESENTATION: The patient was an 83-year-old man with a metastatic
pancreatic cancer who was treated by
gemcitabine as first-line
therapy. He was in good health and received no other
chemotherapy. A dose of 1000 mg/m(2) of
gemcitabine was administered over a 30-minute
intravenous infusion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed. Nevertheless, the patient developed a severe
dyspnea, with arterial
hypoxemia and very low lung diffusion for
carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral
pleural effusion, and lymph node enlargement. On echocardiography, there was a suspicion of
pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed
pulmonary hypertension and normal pulmonary artery occlusion pressure. Diagnosis of PVOD was made, and a
gemcitabine-induced toxicity was suspected. A symptomatic treatment was started. At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood
gases, and echocardiography. A
gemcitabine-induced PVOD is the more likely diagnosis.