Low dose cabergoline induced interstitial pneumonitis

Our plain-English summary of Low dose cabergoline induced interstitial pneumonitis, by W. Frank, R. Moritz, B. Becke, et al (The European Respiratory Journal, 1999).

The study

• Authors: W. Frank, R. Moritz, B. Becke, R. Pauli
• Journal: The European Respiratory Journal
• Published: 1999;14(4):968-70
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Certain dopaminergic anti-Parkinson drugs (ergolines) have repeatedly been identified as a cause of pleuropulmonary disease with a focus on serosal cell damage. Recently, a pathogenetic link between ergolines and prior asbestos exposure was suggested, as regards the development of pleural pathology. This report describes a patient with idiopathic Parkinson's disease, who was on a multiple drug regimen including low dose cabergoline. The patient developed a febrile illness with widespread bilateral lung infiltrations nonresponsive to beta-lactam and macrolide antibiotics. Bronchoalveolar lavage and transbronchial lung biopsy showed a "hypersensitivity-like" interstitial lung disease, which cleared almost completely within 2 months after simple drug withdrawal. Circumstantial evidence suggests a so far undescribed adverse lung reaction to cabergoline, devoid of the more usual pleural changes.

In plain English

This was a case report, from a German lung clinic, about one 65-year-old man with a 12-year history of idiopathic Parkinson's disease. Four months before he first felt unwell, cabergoline (1 mg per day) had replaced clozapin in his drug regimen. He developed fever and a dry cough, and X-ray and CT scans showed patchy shadows in both lungs. No unequivocal pleural changes were seen. Two courses of antibiotics did not help. Fluid washed from his lungs contained 60% lymphocytes and grew no disease-causing organisms. A lung biopsy showed interstitial inflammation with some fibrosis and focal features of desquamative interstitial pneumonia. The ergoline drug was stopped without steroid treatment. He recovered clinically within 3 weeks, and the X-ray changes resolved by the 8- and 12-week checks. The authors concluded that lone lung reactions may occur even with low dose cabergoline, while noting that atypical pneumonia was difficult to rule out definitely. Asbestos is mentioned only in the abstract, the introduction and one cited reference, all concerning an earlier report on other patients. The article describes no asbestos exposure for this patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 65-year-old man with a 12-year history of idiopathic Parkinson's disease, admitted to the authors' lung clinic in Treuenbrietzen, Germany (chest imaging dated January to February 1998)
• Exposure: The anti-Parkinson drug cabergoline at 1 mg per day, which replaced clozapin four months before symptoms began. He also continued to take pergolide, carbidopa/levodopa and benserazid. No asbestos exposure is described for this patient. He had a past flour dust allergy from work as a baker until 1985, and had quit smoking 20 years earlier.
• Main results:
  • Chest imaging showed patchy consolidations in both lungs with no unequivocal pleural changes.
  • The lung infiltrates did not respond to an 8-day course of cefuroxim and a 14-day course of roxythromycin.
  • Lung washing (BAL) fluid grew no pathogenic organisms. Its cells were 28.8% macrophages, 60% lymphocytes and 11.2% neutrophils.
  • The transbronchial biopsy was diagnosed as subacute to chronic nongranulomatous interstitial inflammation with at least focal features of desquamative interstitial pneumonia, with some degree of fibrosis.
  • After the ergoline drug was discontinued without steroids, the patient recovered clinically within 3 weeks. The X-ray changes resolved, as confirmed at the 8- and 12-week follow-ups.
• The authors' conclusion: The authors concluded that lone pulmonary reactions may occur even with low dose cabergoline treatment, as previously reported with a few other ergolines. They described the evidence linking the reaction to the drug as circumstantial.
• Limitations the authors state:
  • The authors stated that atypical pneumonia was difficult to rule out definitely.
  • The authors stated that the nature of the lung lesions remained unclear. Whether the patient's HLA-B27-positive status contributed was only speculation.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Pneumonitis, Asbestos Exposure, Pathology, Idiopathic, Bilateral, Bronchoalveolar Lavage (BAL), Biopsy.

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