Abstract Introduction Gemcitabine is a nucleoside analog used to treat solid tumors, including pancreatic, lung, and renal cancers. Although effective, it can rarely cause pulmonary toxicity, ranging from interstitial pneumonitis to acute respiratory distress syndrome (ARDS). Because its manifestations overlap with infection, heart failure, and metastatic disease, early recognition is essential to prevent life-threatening respiratory failure. Case Report A 43-year-old woman with SMARCB1-deficient metastatic renal medullary carcinoma developed acute dyspnea and hypoxemia approximately two weeks after her second cycle of gemcitabine and carboplatin. She was tachypneic and hypoxic on arrival, requiring noninvasive ventilation followed by high-flow nasal cannula. CT angiography of the chest (Fig₁) showed no pulmonary embolism and diffuse, lower-lobe-predominant patchy airspace and ground-glass opacities with peribronchial thickening and a small right pleural effusion. Laboratory evaluation showed normal white cell count, mild anemia, elevated BNP, and flat troponin trend. Echocardiography demonstrated preserved ventricular function. Respiratory viral PCR was positive for rhinovirus; bacterial cultures were negative. After excluding infectious, cardiac, and embolic causes, gemcitabine-induced lung injury (GILI) was diagnosed. Gemcitabine was discontinued, and intravenous methylprednisolone was started, followed by an oral taper. The patient improved rapidly, with resolution of infiltrates and hypoxemia. Discussion Gemcitabine-induced lung injury is an uncommon yet potentially fatal complication that may develop within days to weeks of therapy. This case is notable for its occurrence in SMARCB1-deficient metastatic renal medullary carcinoma, onset after only two chemotherapy cycles, and confounding factors of rhinovirus infection and extensive pulmonary metastases. Rapid improvement with corticosteroids confirmed the inflammatory, non-infectious nature of the injury. Clinicians should maintain a high index of suspicion for gemcitabine pulmonary toxicity in patients presenting with new-onset respiratory failure soon after chemotherapy. Prompt drug discontinuation and corticosteroid therapy can be lifesaving. This abstract is funded by: None
Worku et al. (Fri,) studied this question.