Acute respiratory failure after interferon-γ therapy of end-stage pulmonary fibrosis

• Published in: American journal of respiratory and critical care medicine 2003-04, Vol.167 (7), p.953-957
• Main Authors: HONORE, Isabelle, NUNES, Hilario, GROUSSARD, Odile, KAMBOUCHNER, Marianne, CHAMBELLAN, Arnaud, AUBIER, Michel, VALEYRE, Dominique, CRESTANI, Bruno
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Dose-Response Relationship, Drug; Drug toxicity and drugs side effects treatment; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Interferon-gamma - administration & dosage; Interferon-gamma - adverse effects; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pulmonary Fibrosis - complications; Pulmonary Fibrosis - drug therapy; Respiratory Insufficiency - chemically induced; Toxicity: respiratory system, ent, stomatology; Treatment Failure
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200208-818CR

Interferon (IFN)-gamma was recently proposed as a treatment for idiopathic pulmonary fibrosis. We report on four patients who developed acute respiratory failure with new alveolar opacities after 2 (two patients), 6, and 35 injections of IFN-gamma-1b. All four patients had advanced idiopathic pulmonary fibrosis (total lung capacity less than 45% predicted or carbon monoxide diffusion capacity less than 30% predicted), and two patients had familial pulmonary fibrosis. No other cause of deterioration was found. Refractory hypoxemia led to death in three cases and to lung transplantation in one case. Pathologic studies in two patients showed diffuse alveolar damage lesions with preexisting usual interstitial pneumonia. These cases suggest that IFN-gamma therapy can induce an acute respiratory failure in patients with end-stage idiopathic pulmonary fibrosis.