2019 Volume 59 Issue 4 Pages 366-371
Background. Although drug-induced interstitial pneumonitis caused by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is well recognized, reports of alveolar hemorrhage caused by EGFR-TKIs are very rare. Case. The patient was a 75-year-old woman who was diagnosed with lung adenocarcinoma (cT2bN0M0, stage IIA) in December 2015. An EGFR L858R mutation in Exon21 and the EGFR T790M mutation in Exon20 were identified before the start of therapy. She chose to undergo chemotherapy without surgery or radiotherapy. She started gefitinib treatment in February 2016. In October 2016, the primary tumor grew and metastasized within the same lobe. Gefitinib was thus discontinued, and osimertinib was started at 80 mg/day in November 2016. Tumor regression was immediately achieved, but bloody sputum was observed 2 months later. Chest computed tomography revealed diffuse ground-glass opacities in the bilateral lung fields. Bronchoscopy was performed, and the patient's bronchoalveolar lavage (BAL) fluid was bloody and showed hemosiderin-laden macrophages. Based on these findings, we diagnosed alveolar hemorrhage. Osimertinib was discontinued, and oral prednisolone was started at a dose of 25 mg/day, out of concern in relation to possible drug-induced alveolar hemorrhage. The patient's symptoms immediately improved. Conclusion. If osimertinib-treated patients show alveolar hemorrhage, the withdrawal of osimertinib and start of steroid therapy should be considered due to the possibility of drug-induced alveolar hemorrhage.
