Pulmonary infiltration with eosinophilia (PIE) syndrome induced by antibiotics, PIPC and TFLX during cancer treatment

Drugs induce a variety of pulmonary diseases including pulmonary infiltrati on with eosinophilia (PIE) syndrome. We report a case of PIE syndrome which was observed after neck dissection. An 83-year-old male patient attended o ur clinic complaining of upper neck swelling and was diagnosed as advanced lymph node metastasis related to previously resected oral carcinoma and und erwent neck dissection. Despite administration of antibiotics (piperacillin sodium, PIPC; and tosufloxacin tosilate, TFLX), fever and an elevation of the c-reactive protein (CRP) level with neutrophilia appeared, and an infil tration shadow was observed in the right lower pulmonary field. With the su spicion of pneumonia, the antibiotics were exchanged for panipenem/betamipr on. However, the pulmonary infiltration spread widely, CRP increased to 12. 9 mg/dl and severe eosinophilia (23%) was observed a few days after changin g the antibiotics. PIE syndrome was suspected, and the patient underwent st eroid mini-pulse therapy consisting of methylprednisolone sodium succinate (500 mg) and prednisolone (60 mg). After steroid therapy, the pulmonary con dition largely improved. However, about 2 weeks after the start of steroid administration, a fever and a further elevation of CRP were observed with a n increase of beta -D-glucan in serum. Roentgenography revealed diffuse inf iltration shadows throughout the lungs, and the patient died about 3 weeks after the onset from respiratory distress. In vitro, blastogenesis of patie nt's peripheral blood lymphocytes was strongly enhanced by PIPC and TFLX, a nd they generated a large amount of interleukin-5 in the presence of PIPC o r TFLX. The clinical course and laboratory examination results revealed tha t PIE syndrome may have been induced by PIPC and TFLX and that PIE syndrome should be suspected in treatment of carcinomas when dyspnea and pulmonary infiltration are complicated with eosinophilia. (C) 2001 Elsevier Science L td. All rights reserved.