Delayed pulmonary fibrosis after nitrosourea therapy

Adverse pulmonary reactions resulting from the use of chemotherapeutic agents are a life-threatening complication of modern cancer therapy. Their recognition and differentiation from lung injuries with infectious or other causes present a continuing diagnostic challenge to physicians treating patients with cancer. Many commonly used chemotherapeutic agents cause pulmonary injury and fibrosis. Until now, bleomycin has been the prototype, with fibrosis occurring in approximately 10 percent of patients receiving this agent, in whom it is fatal in roughly 10 percent.¹ Adverse pulmonary reactions have also been associated with other cytotoxic agents, including busulfan, cyclophosphamide, chlorambucil, methotrexate, cytarabine, and the nitrosourea compounds;.