Severe lenalidomide-induced interstitial pneumonitis requiring mechanical ventilation: Case report and review of literature

To illustrate recognition of drug-induced lung injury and review of all published cases of lenalidomide-induced interstitial pneumonitis. Lenalidomide is an immunomodulatory thalidomide analog currently approved for the treatment of myelodysplastic syndrome and refractory multiple myeloma. Lenalidomide-induced pulmonary toxicity presenting as interstitial pneumonitis has been rarely reported. We report the case of a 62-year-old man with recent diagnosis of myelodysplastic syndrome and concomitant treatment with lenalidomide, presenting with dyspnea, weakness, cough, fever, and diffuse interstitial opacities on chest computed tomography. His symptoms became severe enough to require mechanical ventilation and intubation for respiratory failure, however, showed some response to intravenous corticosteroids. Failure to improve on antibiotics and an extensive work-up that was negative for infectious etiologies, combined with a resurgence of complaints after restarting lenalidomide treatment, led to the diagnosis of severe lenalidomide-induced lung disease. Physicians should recognize drug-induced lung disease and pursue aggressive work-up for definite diagnosis to provide appropriate treatment and prevent fatal recurrences.