A 78-year-old man presented with a history of hypertension, dyslipidemia and ischemic heart disease due to acute myocardial infarction who required double coronary bypass grafting for 22 years.
The patient underwent colonic neoplasia with pathological result of stage III adenocarcinoma (pT3pN2M0).
Given the patient's medical history, the use of fluoroquinidines is not recommended.
For this reason adjuvant chemotherapy was initiated according to the TOMOX scheme at adjusted doses (raltitrexed 2.5 mg/m2 and oxaliplatin 100 mg/m2 every 3 weeks).
A total of 8 cycles are planned.
Tolerance is correct.
At the follow-up visit prior to the seventh cycle, the patient reported having received antibiotic treatment the previous days due to lower respiratory tract infection diagnosed by his family doctor.
The patient was afflicted with mild deterioration of renal function and asthenia grade II. Therefore, it was decided to postpone the cycle.
At this time, the total cumulative doses of raltitrexed and oxaliplatin are 26 mg and 1,040 mg, respectively.
48 hours after the last visit, the patient came to the emergency room for fever of 38.5oC and dyspnea on minimal exertion.
Arterial gas showed parameters compatible with severe respiratory failure.
The chest X-ray showed bilateral pulmonary infiltrates and dubious condensation in the right lower lobe.
The patient was admitted under suspicion of severe pneumonia, starting broad-spectrum empirical antibiotic therapy and non-invasive mechanical ventilation.
Echocardiography ruled out pulmonary thromboembolism.
At 48h, due to respiratory worsening, the patient is transferred to the Intensive Care Unit (ICU) requiring endotracheal intubation.
It is suggested as severe respiratory failure secondary to community-acquired pneumonia without germ vs pulmonary toxicity due to cytological confirmation associated with adult respiratory distress syndrome.
Interactions with the patient's chronic medication are ruled out.
The results of microbiological studies (blood and sputum), as well as serology for atypical microorganisms were all negative.
Chest computed tomography showed diffuse interstitial pneumonitis.
Given the clinical course of the patient, it was decided to start high-dose treatment (prednisone 1mg/kg/day), under suspicion of pulmonary toxicity to corticosteroids.
The evolution of the patient was torpid, with death after 17 days of ICU admission.
