Pulmonary infiltrates caused by a hypersensitivity reaction are not a known side effect of paclitaxel [1-3]. We describe two patients with transient pulmonary infiltrates seen after they received treatment with paclitaxel in combination with carboplatin. We believe that these transient infiltrates probably resulted from a hypersensitivity reaction caused by paclitaxel or the cremophor EL vehicle used in the formulation. Fever and peripheral eosinophilia did not accompany the infiltrates.

The first patient was a 66-year-old woman who began receiving carboplatin and paclitaxel for metastatic non-small-cell lung cancer. Paclitaxel was given at 175 mg/m² body surface area for 24 hours after standard premedication with dexamethasone, diphenhydramine, and a histamine-2 blocker. We compared a chest radiograph obtained 2 weeks after cycle 4 of chemotherapy with a radiograph obtained after cycle 2. The second radiograph showed bilateral patchy nodular infiltrates. The patient was asymptomatic, and results of the physical examination were unremarkable. A chest radiograph obtained 10 days later showed that the infiltrates had almost completely resolved. The patient had rechallenge with chemotherapy, with no resulting respiratory effects or recurrent pneumonitis.

The second patient was a 59-year-old man with stage III B non-small-cell lung cancer who began receiving paclitaxel and carboplatin. Paclitaxel was given at 175 mg/m² for 3 hours after standard premedication. About 48 hours after the infusion of paclitaxel, the patient reported increased shortness of breath with no other symptoms. The chest radiograph showed new lingula and left lower lobe infiltrates. Despite administration of oxygen and intravenous antibiotics, the patient's respiratory status did not change. The patient was given empiric treatment with dexamethasone, 4 mg intravenously every 4 hours. His respiratory status improved during the next 48 hours. A chest radiograph obtained 6 days later showed that the infiltrates had almost completely resolved.

The differential diagnosis of pulmonary infiltrates in these patients included infection, pulmonary edema, or pulmonary hemorrhage. The patients' histories and clinical examinations excluded these conditions. We believe that transient pulmonary infiltrates should be added to the list of the adverse effects of paclitaxel.