Letter to the Editor,
Pulmonary Eosinophilia Caused by Testosterone Cypionate
Eosinofilia pulmonar por cipionato de testosterona
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class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francisco" "apellidos" => "Carrión Valero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Andrea" "apellidos" => "Urbano Salcedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eosinofilia pulmonar por cipionato de testosterona" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 424 "Ancho" => 1344 "Tamanyo" => 137792 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT chest: ground glass opasidad of dominance lower lobes. (B) Bronchoalveolar lavage hyperplastic pneumocytes and significant eosinophilia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of acute lung toxicity with eosinophilia due to testosterone cypionate, which to our knowledge is the first case described in the literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 39-year-old male who presented with sudden onset dyspnoea, coughing with a little blood-stained sputum and feeling feverish. <span class="elsevierStyleItalic">Anamnesis</span>: no substance abuse, firefighter by profession. He was involved in bodybuilding during his spare time and had been using hormone supplements intermittently for 20 years. He had begun a new cycle of testosterone cypionate four weeks earlier, taking a weekly dose of 250<span class="elsevierStyleHsp" style=""></span>mg. On the <span class="elsevierStyleItalic">physical examination</span>, he was found to be in general poor health, with profuse sweating, tachypnoea with respiratory rate 28<span class="elsevierStyleHsp" style=""></span>bpm and temperature of 28<span class="elsevierStyleHsp" style=""></span>°C. Auscultation revealed fine crackles in both lung bases. <span class="elsevierStyleItalic">Arterial blood gases</span>: pH 7.44, PaCO<span class="elsevierStyleInf">2</span> 34<span class="elsevierStyleHsp" style=""></span>mmHg, PaO<span class="elsevierStyleInf">2</span> 62<span class="elsevierStyleHsp" style=""></span>mmHg. <span class="elsevierStyleItalic">Laboratory tests</span>: complete blood count, leukocytes 19,900<span class="elsevierStyleHsp" style=""></span>μl with predominantly neutrophils (88%, 17<span class="elsevierStyleHsp" style=""></span>600/μl), lymphocytes (4%, 810/μl), eosinophils (0.2%, 40/μl), C-reactive protein 13.3<span class="elsevierStyleHsp" style=""></span>mg/l. Quick index 99%. <span class="elsevierStyleSmallCaps">d</span>-dimer 575<span class="elsevierStyleHsp" style=""></span>ng/ml. Blood glucose, renal function and electrolytes are normal. Serum complement and immunoglobulins are normal. Auto-antibodies test is negative. <span class="elsevierStyleItalic">Chest computed tomography (CT) scan</span>: presence of areas of ground-glass opacity predominantly in bases and dependent regions, septal thickening (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). <span class="elsevierStyleItalic">Fibrobronchoscopy</span>: normal. Microbiological study of the bronchoalveolar lavage (BAL) and bronchial aspirate was negative. Pathological study of the BAL showed a smear with a haematic background and abundant cellularity consisting of alveolar macrophages, with a considerable number of atypical hyperplastic pneumocytes and abundant eosinophils (25%), compatible with a diagnosis of eosinophilia with atypical pneumocyte hyperplasia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Initial treatment was prescribed with oxygen therapy, intravenous levofloxacin and anti-pyretics. On the second day of admission, the patient had symptomatic improvement with disappearance of the dyspnoea and control of the fever; the chest radiograph and arterial blood gases were normal on the fifth day. Two weeks later the patient was asymptomatic and had stopped using hormone supplements. The respiratory function examination, including a diffusion test and chest CT, was normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the clinical setting, androgens are mainly used in testosterone replacement therapy in male hypogonadism.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The use of testosterone cypionate, despite being banned in competition, is well known in sport for achieving greater strength and enhanced performance, and in bodybuilding for obtaining a rapid increase in muscle mass. In a literature search performed on Pneumotox<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and MEDLINE up to February 2012, we did not find any association between the use of testosterone cypionate and lung toxicity. However, Ramos Villalobos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported a case similar to ours caused by the use of methenolone, another anabolic substance used in bodybuilding.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The causal relationship with the drug, presence of infiltrates and confirmation of tissue eosinophilia by BAL led us to consider the possibility of lung toxicity,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> having ruled out other infectious, vascular, autoimmune and immunological conditions. In fact, in our case, there was a temporal relationship to the start of four weeks testosterone cypionate therapy from the first dose, and the symptomatology coincided with the recent use of the following dose, which corresponded to the patient according to the cycle that he had been following. Furthermore, he improved rapidly when the drug was withdrawn, with radiology and respiratory function returning to normal. It is important to highlight that systemic corticosteroids were not used.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As often happens with drug-induced lung toxicity, the patient was admitted with suspected community-acquired pneumonia, although this diagnosis was not confirmed either by microbiological studies or the subsequent evolution. In drug-induced lung disease, high resolution CT shows histological findings that resemble those in other entities such as infection and pulmonary fibrosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The finding of eosinophilia in the BAL reinforced the hypothesis of drug toxicity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, the current case together with the case reported recently by Ramos Villalobos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> could provide evidence to indicate that the use of testosterone-derived anabolic substances for sport can cause lung toxicity. Attention should be paid in the future to the use of these substances and their possible relationship with physiopathological changes that lead to lesions in the lung parenchyma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Monclou Garzón E, Carrión Valero F, Urbano Salcedo A. Eosinofilia pulmonar por cipionato de testosterona. Arch Bronconeumol. 2013;49:498–499.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 424 "Ancho" => 1344 "Tamanyo" => 137792 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT chest: ground glass opasidad of dominance lower lobes. (B) Bronchoalveolar lavage hyperplastic pneumocytes and significant eosinophilia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hipogonadismo masculino: causas, genética, diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Jubiz" 1 => "E.A. 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Gonzalez Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.09.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2009" "volumen" => "45" "paginaInicial" => "622" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19875221" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced lung disease, high-resolution CT findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Ellis" 1 => "J.R. Cleverley" 2 => "N.L. 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| 2017 October | 41 | 5 | 46 |
| 2017 September | 57 | 24 | 81 |
| 2017 August | 78 | 9 | 87 |
| 2017 July | 49 | 7 | 56 |
| 2017 June | 73 | 15 | 88 |
| 2017 May | 72 | 5 | 77 |
| 2017 April | 73 | 8 | 81 |
| 2017 March | 72 | 4 | 76 |
| 2017 February | 47 | 7 | 54 |
| 2017 January | 43 | 6 | 49 |
| 2016 December | 47 | 6 | 53 |
| 2016 November | 88 | 13 | 101 |
| 2016 October | 64 | 9 | 73 |
| 2016 September | 50 | 9 | 59 |
| 2016 August | 73 | 8 | 81 |
| 2016 July | 44 | 16 | 60 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 87 | 3 | 90 |
| 2015 September | 62 | 6 | 68 |
| 2015 August | 91 | 5 | 96 |
| 2015 July | 70 | 12 | 82 |
| 2015 June | 46 | 7 | 53 |
| 2015 May | 66 | 7 | 73 |
| 2015 April | 49 | 9 | 58 |
| 2015 March | 43 | 9 | 52 |
| 2015 February | 57 | 6 | 63 |
| 2015 January | 45 | 4 | 49 |
| 2014 December | 59 | 14 | 73 |
| 2014 November | 48 | 12 | 60 |
| 2014 October | 59 | 11 | 70 |
| 2014 September | 30 | 8 | 38 |
| 2014 August | 52 | 12 | 64 |
| 2014 July | 52 | 9 | 61 |
| 2014 June | 62 | 20 | 82 |
| 2014 May | 56 | 9 | 65 |
| 2014 April | 57 | 14 | 71 |
| 2014 March | 43 | 12 | 55 |
| 2014 February | 45 | 13 | 58 |
| 2014 January | 1 | 1 | 2 |
| 2013 December | 0 | 1 | 1 |
| 2013 November | 1 | 0 | 1 |
Show all
