Azacitidine-induced acute lung injury in a patient with therapy-related myelodysplastic syndrome

Abstract

Azacitidine is a first-in-class demethylating agent, and it is widely used globally as a first-line treatment for higher-risk myelodysplastic syndrome (MDS). Here, we report the case of a patient with MDS who suffered from a rare adverse event, an acute lung injury (ALI), which was suspected to have been caused by azacitidine and was successfully treated with corticosteroids. As it is a rare, but critical, adverse event, clinicians should consider ALI as one of the differential diagnoses in cases where 1) pneumonia and fever of unknown etiology arise in MDS patients treated with azacitidine, 2) antimicrobial agents are not effective, and 3) microbiological tests produce negative results.

Keywords: Azacitidine; acute lung injury; follicular lymphoma; myelodysplastic syndrome.

Figure 1.

The patient’s clinical course and changes in body temperature. Abbreviations: Aza, azacitidine; BMA, bone marrow aspiration; BT, body temperature; CRP, C-reactive protein; PSL, prednisolone.

Figure 2.

Chest CT scan obtained on day 4 of cycle 2 of azacitidine treatment (b) exhibited worse findings than a scan acquired at baseline (a). Prednisolone treatment improved these findings on day 25 of cycle 2 (c). However, the re-administration of azacitidine made them worse again on day 4 of cycle 3 (d).