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Vol. 38. Issue 10.
Pages 492-494 (October 2002)
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Vol. 38. Issue 10.
Pages 492-494 (October 2002)
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Toxicidad pulmonar por talidomida
Lung toxicity due to thalidomide
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F. Carrión Valero
Servicios de Neumología Hospital Clínico Universitario. Facultad de Medicina. Universitat de València. Valencia
V. Bertomeu Gonzáleza
a Servicios de Cardiología. Hospital Clínico Universitario. Facultad de Medicina. Universitat de València. Valencia
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La talidomida es un fármaco bien conocido por sus efectos secundarios, aunque la toxicidad pulmonar no ha sido comunicada. Presentamos el caso de un varón de 65 años, diagnosticado de mieloma múltiple IgG kappa en estadio IA, que en el día 37 del tratamiento con talidomida presentó de forma aguda tos, malestar general, disnea de reposo y sudación. La presión arterial era 90/60mmHg y no tenía fie-bre. En la radiografía de tórax había un patrón intersticial alveolar en el hemitórax derecho, y en la gasometría arterial una insuficiencia respiratoria parcial (pH 7,40, PaCO240mmHg, PaO247mmHg). El análisis de sangre evidenció alteraciones propias de su mieloma múltiple y las determinaciones microbiológicas fueron negativas (esputo, hemocultivos y detección de antígenos de Streptococcus pneumoniae y Legionella pneumophilaen orina). Tras la retirada del fármaco y recibir oxigenoterapia y corticoides intravenosos, el paciente evolucionó bien. Una radiografía de tórax realizada 4 días después fue normal y en la gasometría arterial desa-pareció la insuficiencia respiratoria

Como conclusión, cabe mencionar que la toxicidad pulmonar grave deberá ser incluida entre los efectos adversos potenciales de la talidomida

Palabras clave:
Talidomida
Toxicidad pulmonar
Mieloma múl-tiple

Although the side effects of thalidomide are well known, lung toxicity has not been reported. We describe the case of a 65-year-old man with multiple myeloma (IgG kappa) in stage IA who, on the thirty-seventh day of treatment with thalidomide, developed acute coughing, general malaise, dyspnea at rest and sudoresis. Blood pressure was 90/60mm Hg and temperature was normal. An interstitial and alveolar pattern was visible on the right side of a chest film and arterial blood gases indicated partial respiratory insufficiency (pH 7.40, PaCO,240mmHg, PaO247mmHg). Blood analysis showed alterations expected for multiple myeloma and microbiology was negative (sputum and blood cultures and urinary antigen detection for Streptococcus pneumoniae and Legionella pneumophila). After thalidomide was withdrawn and oxygen and intravenous corticoids were administered, outcome was good. A chest film 4 days later was normal and arterial blood gases showed that respiratory insufficiency had disappeared

We conclude that severe lung toxicity should be included among the potential adverse effects of thalidomide

Keywords:
Thalidomide
Lung toxicity
Multiple myeloma
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Bibliografía
[1.]
B. Christie.
Thalidomide victims win review of compensation.
Bmj, 308 (1994), pp. 739
[2.]
E.M. Tansey.
Dark remedy: the impact of thalidomide and its revival as a vital medicine.
N Engl J Med, 345 (2001), pp. 226-227
[3.]
E.P. Sampaio, E.N. Sarno, R. Galilly, Z.A. Cohn, G. Kaplan.
Thalidomide selectively inhibits tumor necrosis factor alpha production by stimulated human monocytes.
J Exp Med, 173 (1991), pp. 699-703
[4.]
S. Singhal, J. Eehta, R. Desikan, D. Ayers, P. Roberson, P. Eddlemon, et al.
Antitumor activity of thalidomide in refractary múltiple myeloma.
N Engl J Med, 341 (1999), pp. 1965-1971
[5.]
N. Raje, K. Anderson.
Thalidomide. A revival story.
N Engl J Med, 341 (1999), pp. 1606-1609
[6.]
E.C III Rosenow.
Drug-induced pulmonary disease.
Dis Mon, 40 (1994), pp. 253-310
[7.]
A.S. Rogers, E. Israel, C.R. Smith, D. Levine, A.M. McBean, C. Valiente, et al.
Physician knowledge, attitudes, and behavior related to reporting adverse drug events.
Arch Intern Med, 148 (1988), pp. 1596-1600
[8.]
T. Parman, M.J. Wiley, P.G. Wells.
Free radical-mediated oxidative DNA damage in the mechanism of thalidomide teratogenicity.
Nat Med, 5 (1999), pp. 582-585
[9.]
C. Marwick.
Thalidomide back-under strict control.
Jama, 278 (1997), pp. 1135-1137
[10.]
E.P. Sampaio, G. Kaplan, A. Miranda, J.A. Nery, C.P. Miguel, S.M. Viana, et al.
The influence of thalidomide on the clinical and immunologic manifestation of erythema nodosum leprosum.
J Infect Dis, 168 (1993), pp. 408-414
[11.]
A. Bousvaros, B. Mueller.
Thalidomide in gastrointestinal disorders.
Drugs, 61 (2001), pp. 777-7787
[12.]
P. Calderon, M. Anzilotti, R. Phelps.
Thalidomide in dermatology. New indications for an old drug.
Int J Dermatol, 36 (1997), pp. 881-887
[13.]
J.A. López Gil.
Talidomida y enfermedad del injerto contra el huésped: bases de una nueva indicación y efectos secundarios.
Med Clin (Barc), 99 (1992), pp. 545-548
[14.]
R.J. Stevens.
The place of thalidomide in the treatment of inflamatory disease.
Lupus, 5 (1996), pp. 257-258
[15.]
A.I. Minchinton, K.H. Fryer, K.R. Wendt, K.A. Clow, M.M. Hayes.
The effect of thalidomide on experimental tumors and metastases.
Anticancer Drugs, 7 (1996), pp. 339-343
[16.]
S. Singhal, J. Mehta.
Thalidomide in cancer: potencial uses and limitations.
BioDrugs, 15 (2001), pp. 163-172
[17.]
R.J. D'Amato, M.S. Loughman, E. Flynn, J. Folkman.
Thalidomide is an inhibitor of angiogenesis.
Proc Natl Acad Sci USA, 91 (1994), pp. 4082-4085
[18.]
D. Ribatti, A. Vacca, B. Nico, F. Quondamatteo, R. Ria, M. Minischetti, et al.
Bone marrow angiogenesis and mast cell density increase simultaneosly with progression of human multiple myeloma.
Br J Cancer, 79 (1999), pp. 451-455
[19.]
C.L. Crawford.
Safety of thalidomide.
Bmj, 308 (1994), pp. 1437-1438
[20.]
S. Ochonsky, J. Verroust, S. Bastuji-Garin, R. Gheradi, J. Revuz.
Thalidomide neuropathy incidence and clinicoelectrophysiologic findings in 42 patients.
Arch Dermatol, 130 (1994), pp. 66-69
[21.]
P. Haslett, J. Tramontana, M. Burroughs, M. Hempstead, G. Kaplan.
Adverse reactions to thalidomide in patients infected with human immunodeficiency virus.
Clin Infect Dis, 24 (1997), pp. 1223-1227
[22.]
T. Passeron, J.P. Lacour, D. Murr, J.P. Ortonne.
Thalidomide-induced amenorrhea: two cases.
Br J Dermatol, 144 (2001), pp. 1292-1293
[23.]
K. Osman, R. Comenzo, S.V. Rajkumar.
Deep venous thrombosis and thalidomide therapy for multiple myeloma.
N Engl J Med, 344 (2001), pp. 1951-1952
[24.]
M. Zangari, E. Anaissie, B. Barlogie, A. Badros, R. Desikan, A.V. Gopal, et al.
Increased risk of deep-vein thrombosis in patients with myeloma receiving thalidomide and chemotherapy.
Blood, 98 (2001), pp. 1614-1615
[25.]
J. De Castro, Y. Viches, M. González.
Toxicidad pulmonar en el tratamiento del cáncer.
Med Clin (Barc), 105 (1995), pp. 661-668
[26.]
J.A. Gullón, R. Fernández, I.J. González.
Toxicidad pulmonar por maprotilina: a propósito de un caso.
Arch Bronconeumol, 36 (2000), pp. 357
[27.]
F. Carrión Valero, J. Marín Pardo.
Toxicidad pulmonar por fármacos.
Arch Bronconeumol, 35 (1999), pp. 550-559
Copyright © 2002. Sociedad Española de Neumología y Cirugía Torácica
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