Vildagliptin‐induced ground‐glass nodules mimicking lung metastases in a cancer patient receiving Lactobacillus probiotic supplementation

• Published in: Thoracic cancer Vol. 11; no. 2; pp. 470 - 474
• Main Authors: Tanaka, Yasuhiro, Soda, Hiroshi, Fukuda, Yuichi, Nio, Kenta, Ono, Sawana, Tomono, Hiromi, Shimada, Midori, Yoshida, Masataka, Harada, Tatsuhiko, Umemura, Asuka, Iwasaki, Keisuke, Yamaguchi, Hiroyuki, Mukae, Hiroshi
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.02.2020; John Wiley & Sons, Inc; Wiley
• Subjects: Aged; Bronchoalveolar lavage; Case Report; Case Reports; Chemotherapy; Diabetes; Diagnosis, Differential; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Female; Humans; Immune system; Immunology; interstitial pneumonia; Lactobacillus - chemistry; Lavage; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - etiology; Lung Neoplasms - secondary; Lymphocytes; Metastasis; Microbiota; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Patients; Pneumonia; Probiotics; Probiotics - adverse effects; Prognosis; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - etiology; Vildagliptin - adverse effects; Bronchoalveolar lavage; interstitial pneumonia; probiotics
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.13292

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.