Drug-induced lung injury is a common adverse effect of chemotherapeutic agents. Diffuse alveolar hemorrhage (DAH) is a fatal complication associated with drug-induced lung injury. Early diagnosis and treatment of DAH is critical, as delayed management can lead to respiratory failure and poor outcomes. However, the diagnosis of DAH is difficult because of the nonspecific clinical manifestations; as such, bronchoscopy is necessary to establish a diagnosis.

The patient presented with fever and dry cough. He had been receiving fluoropyrimidine and oxaliplatin therapy for esophageal squamous cell carcinoma. Chest imaging revealed diffuse ground-glass opacities. Bronchoscopy with bronchoalveolar lavage was performed, which confirmed the diagnosis of DAH. Although the patient’s respiratory status rapidly worsened, high-dose corticosteroid therapy with respiratory support gradually improved the patient’s condition and he was successfully extubated.

Prompt DAH diagnosis and bronchoscopy in patients receiving oxaliplatin-containing chemotherapy presenting with acute respiratory failure are critical for improving outcomes.

• Diffuse alveolar hemorrhage
• Oxaliplatin
• Esophageal neoplasms
• Lung injury
• Drug therapy
• Case report

• chemotherapy side effects
• drug induced interstitial lung disease
• drug-induced pulmonary toxicity
• folfox
• interstitial lung disease
• oxaliplatin
• progressive ild
• pulmonary fibrosis
• steroid therapy

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method for intraabdominal cavity chemotherapy. It combines the benefits of a minimally invasive approach (low morbidity and easy to repeat) with the pharmacokinetic advantages of intraperitoneal administration and tolerance seems excellent. We would like to report one case of a serious adverse event, acute respiratory distress syndrome, which is likely related to oxaliplatin administration; all signs disappeared within a few days.

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• Lung neoplasms
• Pancreatic carcinoma adenocarcinoma
• Pancreatic neoplasms
• Tomography X-ray computed

The regimen of oxaliplatin with 5-fluorouracil plus l-leucovorin (FOLFOX) has become one of the most commonly used first-line chemotherapy for patients with advanced colorectal cancer and it provides an increase in disease-free survival as well as an overall survival benefit. Although FOLFOX chemotherapy has helped to improve the clinical outcomes in these patients, the regimen is associated with some therapeutic issues or uncontrolled side effects. Gastrointestinal, neurosensory, and hematological toxicities have frequently been observed in patients treated with FOLFOX, and consequently, some palliative treatment has been established to combat such complications. However, pulmonary toxicities including drug-induced interstitial pneumonia (DI-IP) is rarely observed in these patients and a curative treatment is yet to be established. DI-IP due to chemotherapy is most commonly observed in patients treated with mitomycin, paclitaxel, docetaxel, or gemcitabine. Steroid therapy is mostly used to treat DI-IP, although the efficacy of such treatments is not supported with adequate evidence. FOLFOX-induced interstitial pneumonia (FIIP) is rarely observed, and several case reports of FIIP treated with steroids have been published previously that showed the mortality is extremely high. Here, we present a 74-year-old woman who received modified FOLFOX6 as adjuvant chemotherapy after rectal cancer surgery. The patient experienced FIIP, which improved after application of steroid pulse (high-dose methylprednisolone at 1,000 mg/day for 3 days) and tapering (starting with prednisolone at 40 mg/day) therapy. Our data suggest that such a steroid therapy could represent an effective treatment option for FIIP.

• Drug-induced pneumonia
• FOLFOX
• Rectal cancer
• Steroid therapy

• FOLFOX-based chemotherapy
• coNLR-PLR
• colorectal cancer
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio

Recently, interstitial lung disease significantly increases and it is difficult to treat. Cyclophosphamide(CP) is one drug administrated in interstitial lung disease, which can also cause pulmonary fibrosis and lung function lesion. This article present a case which exacerbated interstitial pneumonia after treatment by CP, aiming to enhance the understanding of the side effects of CP and standardize usage of the CP.

A patient of nephrotic syndrome administrated with CP suffered respiratory insufficiency requiring mechanical ventilation. Computed tomography (CT) imaging was compatible with interstitial pneumonia(IP). After treating with multimodal combination therapy (corticosteroids, immune globulins), the patient survived. The clinical characteristics of CP-related lung toxicity and/or pulmonary fibrosis should be paid more attention to avoid the serious outcomes.

Although interstitial lung disease induced by CP is rare, with the current widespread usage of CP increases the risks of diffuse interstitial pneumonia and pulmonary fibrosis, which need to be noted in time to get early treatment.

• Cyclophosphamide
• Interstitial pneumonia
• Side effect
• Toxicity