Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4652-4659
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4652
Intravesically instilled gemcitabine-induced lung injury in a patient with invasive urothelial carcinoma: A case report
Xiao-Ming Zhou, Cen Wu, Xiu Gu
Xiao-Ming Zhou, Xiu Gu, Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Xiao-Ming Zhou, Xiu Gu, Department of Respiratory and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Cen Wu, Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Zhou XM, Wu C, and Gu X were responsible for the diagnosis and treatment of the patient; Zhou XM contributed to the data collection and patient follow-up and wrote the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: The patient has given the informed consent for the case report in this manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest relevant to this article to disclose.
CARE Checklist (2016) statement: The manuscript has been checked according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiu Gu, MD, Doctor, Professor, Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. guxiu1968@126.com
Received: April 15, 2020
Peer-review started: April 15, 2020
First decision: July 25, 2020
Revised: July 28, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: October 6, 2020
Processing time: 165 Days and 21.4 Hours
Abstract
BACKGROUND

Gemcitabine is a chemotherapy agent with relatively low toxicities, as a valid option for elderly patients with underlying diseases. Gemcitabine-induced pulmonary toxicities are rare and various, ranging from self-limited episodes of bronchospasm to fatal, progressive, severe, interstitial pneumonitis and respiratory failure. Intravesical gemcitabine instillations are commonly used to reduce recurrence or progression for non–muscle-invasive bladder cancer or urothelial cancer. Few severe toxicities have been reported for the intravesical instillation is assumed to be completely separated from the systemic circulation.

CASE SUMMARY

A 67-year-old patient received 30 cycles of intravesical gemcitabine instillation after transurethral resection and developed a 1-wk fever, cough, hemoptysis, and dyspnea. After a thorough checkup, bilateral consolidation and infiltration of the lungs were documented and a percutaneous lung biopsy confirmed organizing pneumonia after treatment with broad-spectrum empirical antibiotics failed. Tapered corticosteroids were administered, and pulmonary toxicity gradually resolved.

CONCLUSION

Gemcitabine-induced pulmonary toxicities present with various manifestations. In spite of the rare pulmonary involvement by the intravesical gemcitabine instillation, health care professionals who administer gemcitabine chemotherapy in this way should monitor for gemcitabine-induced pulmonary toxicities, particularly in patients with high-risk factors.

Keywords: Gemcitabine; Interstitial lung disease; Lung injury; Organizing pneumonitis; Urothelial carcinoma; Case report; Chemotherapy toxicity

Core Tip: Gemcitabine-induced pulmonary toxicities are rare and various, ranging from self-limited episodes of bronchospasm to fatal, progressive, severe, interstitial pneumonitis and respiratory failure. Intravesical gemcitabine instillations are commonly used to reduce recurrence or progression for non–muscle-invasive bladder cancer or urothelial cancer. Few severe toxicities have been reported for the intravesical instillation is assumed to be completely separate from the systemic circulation. In spite of the rare pulmonary involvement by the intravesical gemcitabine instillation, health care professionals who administer gemcitabine chemotherapy in this way should monitor for gemcitabine-induced pulmonary toxicities, particularly in patients with high-risk factors.