A 35-year-old woman comes to the physician because of a 9-kg (20-lb) weight loss over the past
four months. The spleen tip is palpable 5 cm below the left costal margin. Laboratory studies show:
Hematocrit: 47%
Leukocyte count: 25,500/mm3
Segmented neutrophils: 52%
Bands: 13%
Metamyelocytes: 6%
Eosinophils: 2%
Basophils: 3%
Lymphocytes: 14%
Myelocytes: 10%
Platelet count: 600,000/mm3
After approximately 48 months of aggressive chemotherapy, he develops progressive dyspnea.
Chest x-ray (CXR) shows a reticulonodular pattern. FEV1/FVC is normal. Which of the following
agents is most likely responsible for these findings?
- A) Bleomycin
- B) Busulfan
- C) Doxorubicin
- D) Prednisone
- E) Imatinib
0 voters
The answer is B.
This patient has chronic myelogenous leukemia (CML).
Busulfan, an alkylating agent which may be used in the treatment of CML1
, causes pulmonary
fibrosis.2
Pulmonary fibrosis classically presents with reticular opacities (i.e., a reticulonodular pattern) on
CXR.3 This is colloquially referred to as “honeycombing.”4, 5
FEV1/FVC may be normal or increased in restrictive lung disease. This is supported by Cleveland
Clinic.6 FEV1/FVC is decreased in obstructive lung disease.7
Imatinib, a tyrosine kinase inhibitor8
, is the gold standard treatment for CML.9 It causes fluid
retention / edema.10
Bleomycin is also known to cause pulmonary fibrosis. It is not a classic treatment for CML.11, 12
Doxorubicin, which is a treatment for Hodgkin lymphoma, causes dilated cardiomyopathy.13, 14
Prednisone may be used as an attempted mitigator / treatment for pulmonary fibrosis