s-1-(combination) and Pneumonia--Pneumocystis

Pulmonary injuries due to S-1 have been reported, and these reports have shown an increase in lung cancer following the increased usage of S-1 in treating lung cancer. We report the first case of lung injury due to S-1 in combination with pneumocystis pneumonia (PCP), because the radiological findings and clinical courses were compatible with S-1-induced lung injury combined with PCP. We should consider that S-1 might induce lung injuries which might occur with PCP, especially with a history of drug-induced or radiation-induced lung injuries.

Topics: Aged; Antimetabolites, Antineoplastic; Drug Combinations; Humans; Lung Injury; Lung Neoplasms; Male; Oxonic Acid; Pneumonia, Pneumocystis; Tegafur

We report a death case of a man in his sixties with pneumocystis pneumonia during chemotherapy for gastric cancer. He was diagnosed with cStage IIIB (T4a, N2, H0, P0, M0). Because of bulky N2, systemic chemotherapy of S-1 and CDDP was performed from April 2009. But no reductions were noted after 2 courses. We next treated this patient with S-1 and CPT-11. He had also received corticosteroid treatment for nausea. Because of high fever and choke, he came to our hospital at day 12 in 3 courses, and a severe respiratory failure occurred. CT of the chest showed diffuse ground-glass bilateral opacities, and we immediately started a treatment with trimethoprim-sulfamethozazole and corticosteroid for the possibility of pneumocystis pneumonia. We finally deduced pneumocystis pneumonia from markedly elevated serum beta-D-glucan and PCR positive after hospitalization. In spite of early treatments, he died of bacterial pneumonia and gastric cancer. We should be careful of pneumocystis pneumonia during chemotherapy and corticosteroid treatment.

Topics: Antineoplastic Agents, Phytogenic; Camptothecin; Dexamethasone; Drug Combinations; Fatal Outcome; Glucocorticoids; Humans; Irinotecan; Male; Middle Aged; Oxonic Acid; Pneumonia, Pneumocystis; Stomach Neoplasms; Tegafur; Trimethoprim, Sulfamethoxazole Drug Combination