Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2007.62.2.134 Case Report Gefitinib-Related Interstitial Pneumonia Lee Ho Jin M.D. Nam Seung Bum M.D. Jung Jae Wook M.D. Na Im Il M.D. Kim Cheol Hyeon M.D. Ryoo Baek-Yeol M.D. Choe Du Whan M.D. 1 Kang Jin Hyung M.D. 2 Lee Jae Cheol M.D. Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea. Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea. Department of Internal Medicine, Kangnam St. Mary's Hospital, Seoul, Korea. Address for correspondence: Jae Cheol Lee, M.D. Department of Internal Medicine, Korea Cancer Center Hospital 215-4, Gongneung-Dong, Nowon-Gu, Seoul, 139-706, Korea. Phone: 02-970-1206, Fax: 02-970-2438, jclee@kcch.re.kr 02 2007 28 02 2007 62 2 134 139 23 01 2007 22 02 2007 Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases 2007

Gefitinib is a novel drug used to treat advanced non-small cell lung cancer. However, drug-related interstitial pneumonia is a major life-threatening side effect, which has a worldwide prevalence of 0.3-0.4%. In Japan, the prevalence is high as 3-4% but the actual frequency in Korea has not been officially assessed. We report two cases of gefitinib-induced interstitial lung disease during the treatment of non-small cell lung cancer. High-resolution computerized tomography (HRCT) of one case showed nonspecific ground glass opacity and the chest x-ray of another case showed diffuse bilateral ground glass opacity. The former patient showed a rapid good response to corticosteroid treatment whereas the latter died despite receiving aggressive treatment with high dose corticosteroid and empirical antibiotics.

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(A) Chest X-ray on day 25 of gefitinib therapy. Poorly defined ground glass opacities in right upper lung field has developed. (B) HRCT on day 25 of gefitinib therapy. Besides previously existed large amount of left pleural effusion and nodular thickenings, new ground glass opacity of both upper lung zone has developed.

Chest X-ray 1 week after the discontinuation of gefitinib and steroid treatment. Ground glass opacity of right lung has improved.

Chest X-ray on day 67 of gefitinib therapy. Diffuse poorly defined air-space opacities of both lung has developed.

Chest X-ray one week after high dose steroid and antibiotics therapy. Diffuse poorly defined air-space opacities and volume reduction of both lung have markedly aggravated.

(A) Acute interstitial pneumonia-like observations. (B) Chronic organizing pneumonia-like observations. (C) Acute eosinophilic pneumonia-like observations. (D) Light ground-glass shadows in bilateral lung fields lacking shrinkage of lung field and traction bronchiectasis (With permission, AstraZeneca and Iressa Expert Committee, 2003).