Oxidative-stress induced pulmonary toxicity in a 46-year-old male with G6PD deficiency on chemotherapy

Abstract

Presented herein is the case report of a 46-year-old male with underlying G6PD deficiency who experienced dyspnea, radiographic pulmonary infiltrates, and unexplained tachycardia while on both FOLFOX chemotherapy and febrile neutropenia prophylaxis with G-CSF support. The proposed mechanism of illness was oxidativestress induced pulmonary toxicity mediated by oxaliplatin, G-CSF, and his underlying G6PD deficiency. He was treated through stopping all active chemotherapy agents and initiating oral steroids and nebulized N-acetylcystine. Within five weeks his symptoms had significantly improved, including a near-complete resolution of pulmonary infiltrates. This case report serves to review a general approach to drug-induced pneumonitis, and concurrently highlights the clinical significance of G6PD deficiency in routine patient care. In an increasingly global population, G6PD deficiency should be screened for in at-risk populations to optimize patient outcomes, including cancer patients.

Keywords

• Colon cancer
• Chemotherapy
• G6PD deficiency
• G-CSF
• Pulmonary toxicity