Pulmonary fibrosis induced by cyclophosphamide

OBJECTIVE: To report a case of pulmonary fibrosis resulting from use of cyc lophosphamide as chemotherapy to treat a patient with breast cancer. CASE SUMMARY: We describe the case of a 52-year-old woman with breast cance r who developed pulmonary fibrosis after four cycles of chemotherapy that i ncluded cyclophosphamide. Pulmonary function tests revealed the presence of a severe ventilatory restriction. The open lung biopsy revealed pulmonary fibrosis with vascular sclerosis and signs of pulmonary hypertension. DISMISSION: Cyclophosphamide is an alkylating agent that has been associate d with interstitial pneumonia and pulmonary fibrosis. The frequency of thes e unwanted effects is < 1%. The clinical picture consists of the progressiv e appearance of dyspnea an a nonproductive cough that progresses to severe pulmonary insufficiency. The risk factors described for these complications have been the use of chemotherapy regimens that include other drugs with k nown pulmonary toxicities, the cumulative total dose, the addition of radio therapy, and the use of high doses of cyclophosphamide. CONCLUSIONS: Even though the frequency of pulmonary fibrosis in patients tr eated with cyclophosphamide-based chemotherapy regimens is low, the presenc e of dyspnea and an interstitial pattern in a patient makes it necessary to consider that possible drug toxicity. The open lung biopsy is the most acc urate diagnostic technique for these cases. The discontinuation of cyclopho sphamide and treatment with corticosteroids is usually followed by clinical recovery in approximately 50% of patients and, in some cases, reversal of the lung injury.