Abstract Introduction Chemotherapy-related pneumonitis is an uncommon but potentially severe complication of cytotoxic and targeted agents. Its clinical and radiologic overlap with infectious pneumonia often leads to diagnostic delay, repeated antibiotic exposure and invasive interventions. We describe a case of chemotherapy-induced pleurisy and pneumonitis presenting as recurrent bacterial pneumonia, emphasizing the importance of early suspicion and multidisciplinary evaluation. Case Presentation A 50-year-old woman with metastatic ovarian carcinoma status was receiving combination paclitaxel, carboplatin, and bevacizumab. She had two prior admissions for presumed left-sided pneumonia complicated by parapneumonic effusion requiring chest tube drainage and extended antibiotics, with negative pleural cytology on both occasions.She re-presented with acute onset pleuritic left-sided chest and back pain, diffuse myalgia, and exertional dyspnea. On admission, she was tachycardic and hypertensive with labs notable for leukocytosis. CT chest showed a small, partially loculated left pleural effusion with adjacent consolidation, unchanged from prior admission. Bedside-ultrasound demonstrated pleural thickening without a definite effusion. Despite broad-spectrum antibiotics, symptoms persisted. Given her malignancy history and recurrent presentations, bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy was performed. Bronchial washings showed a lymphocyte-predominant cell differential and negative cultures. Pathology revealed mild chronic pneumonitis and fibrosis without malignancy or infection. She was started on prednisone 1 mg/kg daily, resulting in rapid symptomatic and clinical improvement. Paclitaxel was held, and she was discharged on a steroid taper. Discussion Paclitaxel-induced pneumonitis, reported in approximately 1-5% of patients, represents a hypersensitivity-type lung injury manifesting as organizing pneumonia or nonspecific interstitial pneumonitis. The proposed mechanism involves alveolar epithelial injury and immune-mediated inflammation. While docetaxel has been more commonly associated with pleural complications such as effusion and pleuritis, there is a dearth of pleural involvement described in paclitaxel-induced lung injury. In our patient, the coexistence of pleuritic pain and pleural thickening with rapid improvement after corticosteroids suggests paclitaxel as the likely cause of both pneumonitis and pleural inflammation. Negative cultures, recurrent “pneumonia” unresponsive to antibiotics, and stable imaging should prompt consideration of drug-induced pathology. Bronchoscopy with BAL and biopsy is valuable for excluding infection and confirming inflammatory injury, guiding safe initiation of steroids and chemotherapy modification. Conclusion Chemotherapy-induced pneumonitis and pleurisy should be suspected in patients with recurrent or non-resolving pneumonia on chemotherapy. Prompt recognition, early bronchoscopy, and corticosteroid initiation can prevent morbidity and unnecessary interventions This case highlights a rare manifestation of paclitaxel-induced pleural and parenchymal toxicity, underscoring the need for a high index of suspicion and aggressive diagnostic evaluation. This abstract is funded by: None
Ganesh et al. (2026) studied this question.