A 63-year-old man was diagnosed with Mantle-cell lymphoma in 2009. He was treated with high doses of chemotherapy, followed by stem-cell transplantation with complete remission until January 2013, where the disease recurred in retroperitoneal and mediastinal lymph nodes. The patient was switched to weekly RTX for 4 weeks, followed by a combination of RTX and bendamustin. Prior to the initiation of RTX, his spirometry was normal and PET-CT revealed no lung parenchymal abnormalities.
The patient developed severe cough and exertional dyspnea immediately after treatment with the second series of RTX. Sputum cultures were negative. The patient completed the treatment regimen with four series. Body plethysmography showed restrictive reduction in lung function and low diffusion capacity (DLco 45%). HRCT of the lungs revealed diffuse GGO and nodular changes. BAL fluid analysis and transbronchial biopsies (TBB) revealed signs of eosinophilic inflammation with drug-induced pneumonitis as the possible underlying etiology.
The diagnosis of RTX-ILD was made on clinical, radiological, and histological bases. The patient was treated with prednisolone and follow-up revealed stability of symptoms and lung function parameters.