Chest
Volume 113, Issue 2, February 1998, Pages 548-550
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Selected Reports
Eosinophilic Lung Disease Induced by Bicalutamide: A Case Report and Review of the Medical Literature

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A 69-year-old man with advanced prostate cancer was receiving antiandrogen therapy (bicalutamide [Casodex]). He developed dyspnea, peripheral eosinophilia and bilateral pulmonary interstitial infiltrates. Transbronchial biopsy confirmed pulmonary eosinophilia. Withdrawal of bicalutamide and initiation of steroid therapy resulted in clinical improvement.

Section snippets

Report of a Case

A 69-year-old man had a history of prostate cancer since 1991 with osseous metastasis to the pelvic bones. The patient visited his physician with symptoms of 5 weeks of productive cough with progressive dyspnea on exertion. There were no fever, chills, or rashes. A week prior to admission, a chest x-ray film and a CT scan of the chest were done; these revealed bilateral interstitial infiltrates (Figs 1, 2), and he was empirically treated with oral clarithromycin for 1 week without clinical

Discussion

Bicalutamide is a nonsteroidal antiandrogen agent which exerts its action by competitive inhibition of androgen binding to cytosol androgen receptors in the target tissue. Prostatic cancer is known to be androgen-sensitive and responds to treatment that counteracts the effect of androgen or removes the source of androgen, or both.

There are currently three nonsteroidal antiandrogens available on the market.2 These agents have comparable efficacy but differ in their side effects. Flutamide, the

Conclusions

The data presented demonstrate that a new nonsteroidal antiandrogen agent, bicalutamide, is capable of causing drug-induced eosinophilic lung diseases. As more patients with advanced prostate cancers receive antiandrogen chemotherapy, more cases of drug-induced lung diseases may be encountered. Awareness of this entity is important since treatment entails simple withdrawal of the drug and institution of corticosteroid therapy in severe cases.

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revision accepted June 20.

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