Fourteen adult patients with haematological
malignancies (eight
non-Hodgkin's lymphoma, one
multiple myeloma, one chronic lymphocytic leukaemia, two acute lymphoblastic leukaemia and two acute myeloid leukaemia) developed
acute interstitial pneumonitis (IP) during the course of
chemotherapy. All patients manifested high
fever over 38 degrees C, bilateral diffuse pulmonary interstitial infiltrates in the chest radiograph and severe
hypoxia without
hypercapnia in the arterial blood gas analysis. Pathogenic microorganisms were not detected in repeated examinations in any patient.
Chemotherapy given included various anti-neoplastic drugs. Five patients had received
granulocyte colony-stimulating factor (
G-CSF) for
chemotherapy-induced leucopenia. The onset was associated with an increase of leucocytes in 10 patients. All patients were treated with high dose
steroid hormone and broad spectrum
antibiotics with or without
anti-fungal agents, and three required
mechanical ventilation. Eleven patients quickly recovered from these situations, whereas three died. Autopsies were done in two patients and disclosed pneumocystis carinii (PC)
pneumonitis in one and non-specific pulmonary congestive oedema and
fibrosis in the other. In conclusion, IP of unknown cause could develop in patients with various haematological
malignancies especially at the recovery phase of
chemotherapy-induced leucopenia irrespective of the previous
G-CSF administration. High dose
steroid hormone should be used as
therapy for such patients as soon as possible after exclusion of an infective aetiology.