Vildagliptin-induced ground-glass nodules mimicking lung metastases in a cancer patient receiving Lactobacillus probiotic supplementation.
Yasuhiro TanakaHiroshi SodaYuichi FukudaKenta NioSawana OnoHiromi TomonoMidori ShimadaMasataka YoshidaTatsuhiko HaradaAsuka UmemuraKeisuke IwasakiHiroyuki YamaguchiHiroshi MukaePublished in: Thoracic cancer (2020)
The association between gut microbiota and the lung immune system has been attracting increasing interest. Here, we report a case of pancreatic cancer in which the dipeptidyl peptidase-4 inhibitor vildagliptin induced unusual manifestations of interstitial pneumonia, possibly under the influence of Lactobacillus paraplantarum probiotic supplementation. Chest computed tomography and positron emission tomography showed multiple ground-glass nodules (GGNs) mimicking metastatic lung cancer. Transbronchial biopsy specimens showed mild fibrosis and infiltration of lymphocytes consisting of more CD4+ than CD8+ cells. The CD4+ cells did not include FOXP3+ regulatory T cells. Bronchoalveolar lavage confirmed lymphocytosis with a markedly increased CD4+ /CD8+ ratio of 7.4. The nodules disappeared shortly after vildagliptin and probiotics were withheld. If unusual interstitial pneumonia is observed in some cancer patients, physicians should pay careful attention to their medication history, including probiotic supplements.
Keyphrases
- regulatory t cells
- positron emission tomography
- computed tomography
- induced apoptosis
- cell cycle arrest
- high glucose
- lactic acid
- diabetic rats
- squamous cell carcinoma
- primary care
- drug induced
- ultrasound guided
- bacillus subtilis
- fine needle aspiration
- healthcare
- small cell lung cancer
- nk cells
- endoplasmic reticulum stress
- emergency department
- cell death
- papillary thyroid
- case report
- signaling pathway
- endothelial cells
- peripheral blood
- cell proliferation
- contrast enhanced
- young adults
- adverse drug
- mechanical ventilation
- respiratory failure
- lymph node metastasis
- electronic health record
- image quality