Thalidomide-induced lung injury

Lesión pulmonar inducida por talidomida

Acute respiratory distress syndrome (ARDS), is an entity with high mortality rate and, among its causes, the medications are a main factor. We present a 52-year-old man case study with a record of Multiple Myeloma stage IIIA on BAD treatment and 200 mg Thalidomide outpatient control. He consulted on cough and progressive dyspnea related to high fever in a week of evolution. His blood pressure was 90/70 mmHg, CR 80xmin, RR 26 x min with auscultation of bi-basal crackles with breathing hypoxaemia and alkalemia on the gases pH 7.48, PCO2 24 mmHg, sat 80%, HCO3 18, FiO2 21%, hemogram without leukocytosis 6.53 (103 ) but hypereosinophilia 18%. Thorax x-ray with bilateral alveolar infiltration. Pneumonia was considered due to atypical germs; thus, antibiotic treatment was implemented. Nevertheless the patient exhibited deterioration along with respiratory difficulties, therefore mechanical ventilation was required. All the cultures were negative as well the ones in the alveolar lavage.

The pulmonary biopsy reported eosinophilic pneumonia due possibly to medicine, as a consequence, the Thalidomide was taken away and treatment with Hydrocortisone and resolution of the alveolar infiltrates, hypoxemia and extubation 4 days later. The patient accomplished the criteria of lung damage led by medicine (temporary relation between the symptoms and use of the medication, presence of histopathology in the biopsy; other causes of ARDS were excluded and the symptoms disappeared when using steroids and suspending medication) being the thalidomide the cause; currently there are two reports of cases in world literature which would support our diagnosis. 

Research, report of new cases and development of prospective studies to determine the possible relationship between Thalidomide and Lung Damage will lead us define exactly if there is a cause-relation ; thus, we will be aware for an early diagnosis avoiding morbid-mortality in the future.