LAUSR

Multiple myeloma is the second most common cancer of the blood. Despite significant advances in treatment, it is considered an incurable disease, response to treatment is limited in duration, and the clinical course is generally relapsing. The combination of lenalidomide and dexamethasone is the therapeutic regimen of choice in relapse. Few cases of long-term lung toxicity presenting as organizing pneumonia in patients receiving this treatment have been reported in the literature. We report the case of a patient with a diagnosis of multiple myeloma, receiving lenalidomide, who developed dyspnea and pulmonary infiltrates. This is the first description of lenalidomide-induced lung toxicity in Spain. This was a 64-year-old man, former smoker, who was diagnosed with IgA kappa multiple myeloma in 2012. He initially received 6 cycles of bendamustine, Velcade ® and prednisone, in addition to autologous stem cell transplantation. In 2014, he relapsed, and began second-line treatment with monthly lenalidomide and dexamethasone. In 2015, he was admitted on 3 occasions with a diagnosis of pneumonia, treated with empirical antibiotics and short-term tapering corticosteroids. At the time of the last admission, he presented with a clinical picture of dyspnea, low-grade fever, and cough. The patient was admitted to the ward with a diagnosis of community-acquired pneumonia; PCR for influenza A and B, and antigens in blood for Legionella and pneumococcus were negative. Empirical treatment was started with levofloxacin, corticosteroids, and oxygen therapy. Seven days after admission, coinciding with discontinuation of steroid treatment, the patient’s clinical situation worsened, and he developed severe respiratory failure, and bilateral pulmonary infiltrates on chest radiograph, so a high-resolution CT (HRCT) was performed, showing extensive bilateral, diffuse, ground glass