Case Report
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World J Clin Oncol. Jul 10, 2011; 2(7): 299-302
Published online Jul 10, 2011. doi: 10.5306/wjco.v2.i7.299
An oral fluoropyrimidine agent S-1 induced interstitial lung disease: A case report
Hiromichi Yamane, Masahide Kinugawa, Shigeki Umemura, Yasuhiro Shiote, Kenichiro Kudo, Toshimitsu Suwaki, Haruhito Kamei, Nagio Takigawa, Katsuyuki Kiura
Hiromichi Yamane, Masahide Kinugawa, Shigeki Umemura, Yasuhiro Shiote, Kenichiro Kudo, Toshimitsu Suwaki, Haruhito Kamei, Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, 3-1 Ohji-cho, Niihama, Ehime 792-8543, Japan
Hiromichi Yamane, Nagio Takigawa, 4th Department of General Medicine, Kawasaki Medical School, 2-1-80 Nakasange, Okayama 700-8505, Japan
Nagio Takigawa, Katsuyuki Kiura, Department of Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama 700-8558, Japan
Author contributions: Yamane H and Kinugawa M analyzed the bibliographical data; Yamane H, Kinugawa M, Umemura S, Shiote Y, Kudo K, Suwaki T and Kamei H were involved in the case of the patient; Yamane H, Takigawa N and Kiura K wrote the paper.
Correspondence to: Hiromichi Yamane, MD, PhD, Director, Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, 3-1Ohji-cho, Niihama, Ehime 792-8543, Japan. hiromichi_yamane@ni.sbh.gr.jp
Telephone: +81-897-377111 Fax: +81-897-377121
Received: March 22, 2011
Revised: May 19, 2011
Accepted: May 26, 2011
Published online: July 10, 2011
Abstract

A 66-year-old Japanese man with pancreatic cancer received eleven courses of gemcitabine monotherapy. The tumor responded to gemcitabine until metastatic liver tumors progressed. Subsequently, he was treated with S-1, an oral fluoropyrimidine anticancer agent, as salvage chemotherapy. Forty-two days after initiating S-1, he presented with dyspnea and fever. Chest computed tomography showed diffuse interstitial lesions with thickening of the alveolar septa and ground glass opacity. Serum KL-6 level was elevated to 1,230 U/mL and he did not use any other drugs except insulin. Thus, the development of interstitial lung disease (ILD) was considered to be due to S-1. Arterial blood oxygen pressure was 49.6 Torr in spite of oxygen administration (5 L/min). Steroid therapy improved his symptoms and the interstitial shadows on chest radiograph. Although S-1-induced ILD has mostly been reported to be mild, clinicians should be aware that S-1 has the potential to cause fatal ILD.

Keywords: Corticosteroid therapy; Interstitial lung disease; Pancreatic cancer; S-1