Pneumocystis pneumonia versus rituximab-induced interstitial lung disease in lymphoma patients receiving rituximab-containing chemotherapy.

Abstract

It is difficult to differentiate Pneumocystis pneumonia (PCP) from rituximab-induced interstitial lung disease (RILD) in lymphoma patients with diffuse pulmonary infiltrates who are receiving rituximab-containing chemotherapy. Using a clinical scoring system, we aim to differentiate PCP from RILD who are receiving rituximab-containing chemotherapy. We reviewed the medical records of lymphoma patients who had received rituximab-containing chemotherapy between 2012 and 2015 in a tertiary hospital. Among 613 lymphoma patients receiving rituximab-containing chemotherapy, 97 (16%) had diffuse pulmonary infiltrates. Of these, 16 (16%) with an alternative diagnosis and 22 (23%) with an indeterminate diagnosis were excluded. Finally, 21 (22%) patients were classified as having PCP and the remaining 38 (39%) as having RILD. Fever, short duration of symptoms (≤5 days), systemic inflammatory response syndrome (SIRS), and severe extent of disease on CT scan (>75%) were more common in patients with PCP than in those with RILD. Clinical scores were determined using the following system: SIRS = score 1, symptom duration ≤5 days = score 1, extent of disease on CT >75% = score 4. A score of ≥2 differentiated PCP from RILD with 91% sensitivity (95% CI, 70-99) and 71% specificity (95% CI, 54-84). A clinical scoring system based on presence of SIRS, short duration of symptoms, and severe extent of disease on CT scan appears to be useful in differentiation of PCP from RILD.

• Authors: Se Yoon Park, Mi Young Kim, Won Jin Choi, Dok Hyun Yoon, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Cheolwon Suh, Jun Hee Woo, Sung-Han Kim
• Journal: Medical mycology (Med Mycol) Vol. 55 Issue 4 Pg. 349-357 (Jun 01 2017) ISSN: 1460-2709 [Electronic] England
• PMID: 28339533 (Publication Type: Journal Article)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Antineoplastic Agents, Immunological
• Rituximab

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Immunological (adverse effects, therapeutic use)
• Decision Support Techniques
• Diagnosis, Differential
• Drug Therapy (methods)
• Female
• Humans
• Lung Diseases, Interstitial (chemically induced, diagnosis, pathology)
• Lymphoma (complications, drug therapy)
• Male
• Middle Aged
• Pneumonia, Pneumocystis (diagnosis, pathology)
• Retrospective Studies
• Rituximab (adverse effects, therapeutic use)
• Tertiary Care Centers
• Young Adult