Individualized therapy as a consequence of the hydroxyurea pulmonary toxicity in a 43-year-old man with essential thrombocythemia

Abstract

Hydroxyurea (HU) is generally used to treat high risk patients with essential thrombocythemia(ET). This agent is usually well tolerated however we now report a case of lung complicationsarising from its use. A 43-year-old man with ET presented with interstitial changes in lungsduring HU therapy. Prior to therapy chest x-rays were normal but after four weeks of using1.0 g daily HU doses, symptoms of pneumonia appeared with a fever of up to 40 °C. Despite antibiotic treatment, x-ray monitoring revealed that bilateral disseminated changes in thecentral and lower lungs regions still persisted and following computed tomography,micronodular changes and finely spotted condensations were observed in these regions as wellas the beginnings of fibrosis and intensified emphysema in peripheral areas. Infectiouspathogenesis was excluded. Hydroxyurea therapy was stopped after 12 months due to concernsabout the lungs slowly undergoing spontaneous regression in these areas. The patient wassubsequently treated with busulfan and finally anagrelide where chest x-rays then showed onlythe presence of emphysema without any further detected pathologies.