INTERSTITIAL PNEUMONITIS PROBABLY INDUCED BY CYCLOPHOSPHAMIDE IN NEPHROSIS

A case of interstitial shadows associated with oral cyclophosphamide t herapy in a 32-month-old girl with steroid-resistant nephrotic syndrom e, who was admitted to the Nishi-Kobe Medical Center with systemic ede ma, is reported. Due to the lack of response to prednisolone, cyclopho sphamide was also administered orally at a dose of 3 mg/kg per day, 4 weeks after the start of steroid therapy. Approximately 3 weeks after the combination treatment she developed a fever, dry cough and cyanosi s. Radiographic examination showed diffuse ground-glass shadow in both lungs, presumably indicating that she had interstitial pneumonitis. H er pulmonary signs and symptoms deteriorated despite various antimicro bial treatments. A discontinuation of cyclophosphamide and the adminis tration of high-dose methylprednisolone yielded a dramatic improvement . These findings suggest that the diffuse pulmonary disease in this ca se was induced by cyclophosphamide. Since interstitial pneumonitis may be fatal and irreversible, attention should be paid to this rare comp lication even in patients undergoing low-dose oral cyclophosphamide tr eatment.