C48-27 Drug-Induced Acute Eosinophilic Pneumonia Due to Oxaliplatin

Abstract Introduction Drug-induced acute eosinophilic pneumonia (AEP) is a rare but serious complication. It is estimated that approximately 17% of AEP cases are attributed to medications, including antimicrobials, antidepressants, NSAIDs and chemotherapeutics. The diagnosis of AEP relies on bronchoalveolar lavage (BAL) demonstrating greater than 25% eosinophils. We present a case of AEP in a patient receiving oxaliplatin. Case Presentation A 44-year-old male with past medical history significant for stage IV rectal adenocarcinoma with metastasis to bone, lungs, and liver actively receiving systemic therapy with FOLFOXIRI (folinic acid, fluorouracil, oxaliplatin and irinotecan) and bevacizumab and chronic hypoxic respiratory failure on 4L nasal cannula at baseline. The patient presented with progressive dyspnea and non-productive cough for a 2-week duration. Of note, he had been hospitalized for similar symptoms and discharged on antibiotics for presumed community acquire pneumonia one week prior. CT chest showed worsening diffuse ground glass opacities in the bilateral upper lobes, middle lobe, and lingula with dense consolidative changes in the bilateral lower lobes. He initially required non-invasive ventilation but due to worsening respiratory failure, he was transferred to the ICU, and placed on mechanical ventilation. Bronchoscopy with BAL ruled out diffuse alveolar hemorrhage but revealed an eosinophil differential of 30%. Infectious evaluation including bacterial, viral, and fungal cultures were negative. Following careful review of medication exposures and other causes of pulmonary eosinophilia, a diagnosis of oxaliplatin induced AEP was made. The patient was started on methylprednisolone 1g for 3 days followed by 1 mg/kg. The patient developed severe ARDS physiology and was managed with low tidal ventilation strategy and proning. The patient’s oxygenation continued to worsen with the development of hemodynamic instability and end organ dysfunction. He was transitioned to comfort directed care and died following 6 days of treatment. Discussion This case outlines the presentation, treatment, and progression of a patient with oxaliplatin induced AEP. Lung toxicity associated with oxaliplatin is rare but associated with high mortality, estimated 75%. Diagnosis of AEP requires a BAL cell count differential of 25% eosinophils with exclusion of alternative etiologies of pulmonary eosinophilia. Glucocorticoids are the mainstay of treatment. Discontinuation of oxaliplatin is recommended. This abstract is funded by: None