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Noninfectious Lung Infiltrates That May Be Confused with Pneumonia in the Cancer Patient

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Principles and Practice of Cancer Infectious Diseases

Part of the book series: Current Clinical Oncology ((CCO))

Abstract

The clinical and radiographic presentation of noninfectious pulmonary disease can often mimic pneumonia in the cancer patient. This chapter provides an overview of some of the most commonly observed noninfectious entities which may be observed in the immunocompromised host with cancer. Hydrostatic and nonhydrostatic pulmonary edema, as well as transfusion-related acute lung injury, may cause bilateral airspace opacification that may be confused with an infectious process. Chemotherapy induced lung injury can occur with many classes of chemotherapeutic agents and requires a high index of clinical suspicion for diagnosis. It often results in distinct patterns of pathologic injury, which may present acutely, subacutely or chronically, and in some cases, up to years after initial administration of the chemotherapeutic agent. Radiation induced lung injury often causes a distinct pattern of radiographic abnormalities, which may occur many months after the initial radiation exposure. In hematopoietic stem cell transplant recipients, many pulmonary diagnoses, such as engraftment syndrome, idiopathic pneumonia syndrome and diffuse alveolar hemorrhage (occurring early) and cryptogenic organizing pneumonia (occurring late), can mimic infectious pneumonias. Small airway mucus impaction can present with tree-in-bud opacities on chest CT and mimics infectious bronchiolitis. It may resolve with only pulmonary hygiene maneuvers. A combined approach involving careful review of the patient’s history, pattern of infiltrates on chest CT, and the use of bronchoscopy with bronchoalveolar lavage with or without transbronchial lung biopsy can often help provide clues to the noninfectious diagnosis.

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References

  1. Yeh ET, Bickford C. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009;53(24):2231–47.

    Article  PubMed  CAS  Google Scholar 

  2. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391–479.

    Article  PubMed  Google Scholar 

  3. Wilson JF. In the Clinic. Heart failure. Ann Intern Med. 2007;147(11):ITC12-11–16.

    Google Scholar 

  4. Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med. 2005;353(26):2788–96.

    Article  PubMed  CAS  Google Scholar 

  5. Maeder MT, Kaye DM. Heart failure with normal left ventricular ejection fraction. J Am Coll Cardiol. 2009;53(11):905–18.

    Article  PubMed  Google Scholar 

  6. Kollef MH, Schuster DP. The acute respiratory distress syndrome. N Engl J Med. 1995;332(1):27–37.

    Article  PubMed  CAS  Google Scholar 

  7. Piantadosi CA, Schwartz DA. The acute respiratory distress syndrome. Ann Intern Med. 2004;141(6):460–70.

    Article  PubMed  Google Scholar 

  8. Lohani S, O’Driscoll BR, Woodcock AA. 25-year study of lung fibrosis following carmustine therapy for brain tumor in childhood. Chest. 2004;126(3):1007.

    Article  PubMed  Google Scholar 

  9. Grande C, Villanueva MJ, Huidobro G, Casal J. Docetaxel-induced interstitial pneumonitis following non-small-cell lung cancer treatment. Clin Transl Oncol. 2007;9(9):578–81.

    Article  PubMed  CAS  Google Scholar 

  10. Sleijfer S. Bleomycin-induced pneumonitis. Chest. 2001;120(2):617–24.

    Article  PubMed  CAS  Google Scholar 

  11. Rivera MP, Kris MG, Gralla RJ, White DA. Syndrome of acute dyspnea related to combined mitomycin plus vinca alkaloid chemotherapy. Am J Clin Oncol. 1995;18(3):245–50.

    Article  PubMed  CAS  Google Scholar 

  12. Camus P, Bonniaud P, Fanton A, Camus C, Baudaun N, Foucher P. Drug-induced and iatrogenic infiltrative lung disease. Clin Chest Med. 2004;25(3):479–519, vi.

    Article  PubMed  Google Scholar 

  13. Copper Jr JA. Drug-induced lung disease. Adv Intern Med. 1997;42:231–68.

    PubMed  Google Scholar 

  14. Erasmus JJ, McAdams HP, Rossi SE. High-resolution CT of drug-induced lung disease. Radiol Clin North Am. 2002;40(1):61–72.

    Article  PubMed  Google Scholar 

  15. Morikawa M, Demura Y, Mizuno S, Ameshima S, Ishizaki T, Okazawa H. FDG positron emission tomography imaging of drug-induced pneumonitis. Ann Nucl Med. 2008;22(4):335–8.

    Article  PubMed  Google Scholar 

  16. Costabel U, Guzman J, Bonella F, Oshimo S. Bronchoalveolar lavage in other interstitial lung diseases. Semin Respir Crit Care Med. 2007;28(5):514–24.

    Article  PubMed  Google Scholar 

  17. Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996;71(1):5–13.

    Article  PubMed  CAS  Google Scholar 

  18. Bollee G, Sarfati C, Thiery G, et al. Clinical picture of Pneumo­cystis jiroveci pneumonia in cancer patients. Chest. 2007;132(4):1305–10.

    Article  PubMed  Google Scholar 

  19. McDonald S, Rubin P, Phillips TL, Marks LB. Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys. 1995;31(5):1187–203.

    Article  PubMed  CAS  Google Scholar 

  20. De Jaeger K, Seppenwoolde Y, Boersma LJ, et al. Pulmonary function following high-dose radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2003;55(5):1331–40.

    Article  PubMed  Google Scholar 

  21. Abid SH, Malhotra V, Perry MC. Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol. 2001;13(4):242–8.

    Article  PubMed  CAS  Google Scholar 

  22. Arbetter KR, Prakash UB, Tazelaar HD, Douglas WW. Radiation-induced pneumonitis in the “nonirradiated” lung. Mayo Clin Proc. 1999;74(1):27–36.

    Article  PubMed  CAS  Google Scholar 

  23. Catane R, Schwade JG, Turrisi 3rd AT, Webber BL, Muggia FM. Pulmonary toxicity after radiation and bleomycin: a review. Int J Radiat Oncol Biol Phys. 1979;5(9):1513–8.

    Article  PubMed  CAS  Google Scholar 

  24. Gross N. Pulmonary effects of radiation therapy. Ann Intern Med. 1977;86:81–92.

    Article  PubMed  CAS  Google Scholar 

  25. Rubin P, Casarett GW. Clinical radiation pathology. Philadelphia: WB Saunders; 1968. p. 423–70.

    Google Scholar 

  26. Stover DE, Milite F, Zakowski M. A newly recognized syndrome: radiation-related bronchiolitis obliterans and organizing pneumonia. A case report and literature review. Respiration. 2001;68(5):540–4.

    Article  PubMed  CAS  Google Scholar 

  27. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170(1):22–48.

    Article  PubMed  Google Scholar 

  28. Limdo H, Lee J, Lee HG, et al. Pulmonary complications after hematopoietic stem cell transplantation. J Korean Med Sci. 2006;21(3):406–11.

    Article  Google Scholar 

  29. Spitzer TR. Engraftment syndrome following hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;27(9):893–8.

    Article  PubMed  CAS  Google Scholar 

  30. Capizzi SA, Kumar S, Huneke NE, et al. Peri-engraftment respiratory distress syndrome during autologous hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;27(12):1299–303.

    Article  PubMed  CAS  Google Scholar 

  31. Clark JG, Hansen JA, Hertz MI, Parkman R, Jensen L, Peavy HH. NHLBI workshop summary. Idiopathic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Dis. 1993;147(6 Pt 1):1601–6.

    Article  PubMed  CAS  Google Scholar 

  32. Watkins TR, Chien JW, Crawford SW. Graft versus host-associated pulmonary disease and other idiopathic pulmonary complications after hematopoietic stem cell transplant. Semin Respir Crit Care Med. 2005;26(5):482–9.

    Article  PubMed  Google Scholar 

  33. Yanik G, Hellerstedt B, Custer J, et al. Etanercept (Enbrel) administration for idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2002;8(7):395–400.

    Article  PubMed  CAS  Google Scholar 

  34. Yanik GA, Ho VT, Levine JE, et al. The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. Blood. 2008;112(8):3073–81.

    Article  PubMed  CAS  Google Scholar 

  35. Tun HW, Wallace KH, Grinton SF, Khoor A, Burger CD. Etanercept therapy for late-onset idiopathic pneumonia syndrome after nonmyeloablative allogeneic hematopoietic stem cell transplantation. Transplant Proc. 2005;37(10):4492–6.

    Article  PubMed  CAS  Google Scholar 

  36. Shukla M, Yang S, Milla C, Panoskaltsis-Mortari A, Blazar BR, Haddad IY. Absence of host tumor necrosis factor receptor 1 attenuates manifestations of idiopathic pneumonia syndrome. Am J Physiol Lung Cell Mol Physiol. 2005;288(5):L942–9.

    Article  PubMed  CAS  Google Scholar 

  37. Robbins RA, Linder J, Stahl MG, et al. Diffuse alveolar ­hemorrhage in autologous bone marrow transplant recipients. Am J Med. 1989;87(5):511–8.

    Article  PubMed  CAS  Google Scholar 

  38. Afessa B, Tefferi A, Litzow MR, Krowka MJ, Wylam ME, Peters SG. Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med. 2002;166(5):641–5.

    Article  PubMed  Google Scholar 

  39. Jules-Elysee K, Stover DE, Yahalom J, White DA, Gulati SC. Pulmonary complications in lymphoma patients treated with high-dose therapy autologous bone marrow transplantation. Am Rev Respir Dis. 1992;146(2):485–91.

    Article  PubMed  CAS  Google Scholar 

  40. Majhail NS, Parks K, Defor TE, Weisdorf DJ. Diffuse alveolar hemorrhage and infection-associated alveolar hemorrhage following hematopoietic stem cell transplantation: related and high-risk clinical syndromes. Biol Blood Marrow Transplant. 2006;12(10):1038–46.

    Article  PubMed  Google Scholar 

  41. Lewis ID, DeFor T, Weisdorf DJ. Increasing incidence of diffuse alveolar hemorrhage following allogeneic bone marrow transplantation: cryptic etiology and uncertain therapy. Bone Marrow Transplant. 2000;26(5):539–43.

    Article  PubMed  CAS  Google Scholar 

  42. Salzman D, Adkins DR, Craig F, Freytes C, LeMaistre CF. Malignancy-associated pulmonary veno-occlusive disease: report of a case following autologous bone marrow transplantation and review. Bone Marrow Transplant. 1996;18(4):755–60.

    PubMed  CAS  Google Scholar 

  43. Trobaugh-Lotrario AD, Greffe B, Deterding R, Deutsch G, Quinones R. Pulmonary veno-occlusive disease after autologous bone marrow transplant in a child with stage IV neuroblastoma: case report and literature review. J Pediatr Hematol Oncol. 2003;25(5):405–9.

    Article  PubMed  Google Scholar 

  44. Mandel J, Mark EJ, Hales CA. Pulmonary veno-occlusive disease. Am J Respir Crit Care Med. 2000;162(5):1964–73.

    Article  PubMed  CAS  Google Scholar 

  45. Kuroda T, Hirota H, Masaki M, et al. Sildenafil as adjunct therapy to high-dose epoprostenol in a patient with pulmonary veno-occlusive disease. Heart Lung Circ. 2006;15(2):139–42.

    Article  PubMed  Google Scholar 

  46. Barreto AC, Franchi SM, Castro CR, Lopes AA. One-year follow-up of the effects of sildenafil on pulmonary arterial hypertension and veno-occlusive disease. Braz J Med Biol Res. 2005;38(2):185–95.

    Article  PubMed  CAS  Google Scholar 

  47. Cordonnier C, Fleury-Feith J, Escudier E, Atassi K, Bernaudin JF. Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients. Am J Respir Crit Care Med. 1994;149(3 Pt 1):788–94.

    Article  PubMed  CAS  Google Scholar 

  48. Tomonari A, Shirafuji N, Iseki T, et al. Acquired pulmonary alveolar proteinosis after umbilical cord blood transplantation for acute myeloid leukemia. Am J Hematol. 2002;70(2):154–7.

    Article  PubMed  Google Scholar 

  49. Beccaria M, Luisetti M, Rodi G, et al. Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J. 2004;23(4):526–31.

    Article  PubMed  CAS  Google Scholar 

  50. Tazawa R, Hamano E, Arai T, et al. Granulocyte-­macrophage colony-stimulating factor and lung immunity in pulmonary alveolar proteinosis. Am J Respir Crit Care Med. 2005;171(10):1142–9.

    Article  PubMed  Google Scholar 

  51. Afessa B, Litzow MR, Tefferi A. Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;28(5):425–34.

    Article  PubMed  CAS  Google Scholar 

  52. Maldonado F, Daniels CE, Hoffman EA, Yi ES, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: causes, clinicoradiologic features, and outcomes. Chest. 2007;132(5):1579–83.

    Article  PubMed  Google Scholar 

  53. Mokhtari M, Bach PB, Tietjen PA, Stover DE. Bronchiolitis obliterans organizing pneumonia in cancer: a case series. Respir Med. 2002;96(4):280–6.

    Article  PubMed  CAS  Google Scholar 

  54. Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest. 2005;128(5):3611–7.

    Article  PubMed  Google Scholar 

  55. Papadopoulos EB, Ladanyi M, Emanuel D, et al. Infusions of donor leukocytes to treat Epstein–Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation. N Engl J Med. 1994;330(17):1185–91.

    Article  PubMed  CAS  Google Scholar 

  56. Loren AW, Tsai DE. Post-transplant lymphoproliferative disorder. Clin Chest Med. 2005;26(4):631–45, vii.

    Article  PubMed  Google Scholar 

  57. Milpied N, Vasseur B, Parquet N, et al. Humanized anti-CD20 monoclonal antibody (Rituximab) in post transplant B-lymphoproliferative disorder: a retrospective analysis on 32 patients. Ann Oncol. 2000;11 Suppl 1:113–6.

    Article  PubMed  Google Scholar 

  58. Wilczynski SW, Erasmus JJ, Petros WP, Vredenburgh JJ, Folz RJ. Delayed pulmonary toxicity syndrome following high-dose chemotherapy and bone marrow transplantation for breast cancer. Am J Respir Crit Care Med. 1998;157(2):565–73.

    Article  PubMed  CAS  Google Scholar 

  59. Holness L, Knippen MA, Simmons L, Lachenbruch PA. Fatalities caused by TRALI. Transfus Med Rev. 2004;18(3):184–8.

    Article  PubMed  Google Scholar 

  60. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion. 1985;25(6):573–7.

    Article  PubMed  CAS  Google Scholar 

  61. Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest. 2004;126(1):249–58.

    Article  PubMed  Google Scholar 

  62. Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC. Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N Engl J Med. 2006;354(3):241–50.

    Article  PubMed  CAS  Google Scholar 

  63. Elkins MR, Robinson M, Rose BR, et al. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med. 2006;354(3):229–40.

    Article  PubMed  CAS  Google Scholar 

  64. Lee A. VTE in patients with cancer-diagnosis, prevention, and treatment. Thromb Res. 2008;123 Suppl 1:S50–4.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Pulmonary Medicine Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Rana Kaplan

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  1. Rana Kaplan
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  2. Lara Bashoura
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  3. Vickie R. Shannon
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  4. Burton F. Dickey
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  5. Diane E. Stover
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Correspondence to Rana Kaplan .

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  1. MD Anderson Cancer Center, Infectious Diseases Department, The University of Texas, 800 5th Avenue, Apt. 12-G, New York, 10065, New York, USA

    Amar Safdar

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Kaplan, R., Bashoura, L., Shannon, V.R., Dickey, B.F., Stover, D.E. (2011). Noninfectious Lung Infiltrates That May Be Confused with Pneumonia in the Cancer Patient. In: Safdar, A. (eds) Principles and Practice of Cancer Infectious Diseases. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-644-3_13

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  • DOI: https://doi.org/10.1007/978-1-60761-644-3_13

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  • Publisher Name: Humana Press, Totowa, NJ

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