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Background: A 4-week interval between radiotherapy and gemcitabin chemotherapy is recommended due to the risk of severe radiosensitization. Gemcitabin can also have severe lung toxicity late after or without prior radiotherapy., Case Report: A patient was treated with thoracic radiotherapy for non-small-cell lung cancer. Five weeks later gemcitabin was given. A few days after the second gemcitabin cycle the patient developed severe respiratory distress. The clinical course was rapidly fatal despite corticosteroid therapy., Discussion: About 20 cases of severe lung toxicity due to gemcitabin have been reported in the literature, occurring late after radiotherapy or without radiotherapy. Corticosteroid therapy, whether given for prevention or cure, is not always effective. Four of these cases had a fatal outcome. The development of brief mild episodes of dyspnea is considered to be common after delivery of gemcitabin. If unexplained dyspnea persists for more than a few hours, severe lung toxicity is highly likely and gemcitabin should be interrupted.

Background: Hydroxyurea has few side effects excepting the known bone marrow toxicity. Fever with or without pneumonia has occasionally been reported., Case Report: A patient given hydroxyurea for polycythemia suddenly developed severe interstitial pneumonia with fever and hypoxemia. All bacteriological tests were negative and an empirical antibiotic regimen was ineffective. Fever recurred after reintroducing hydroxyurea and definitive cure was achieved after its withdrawal. The clinical course was rapidly favorable without the need for corticosteroids., Discussion: Fever, and in some cases interstitial pneumonia, in patients given hydroxyurea generally suggests an infection. However, 15 cases of pneumonia have been reported as caused by hydroxyurea in patients treated for a myeloproliferative syndrome. Delay to onset is 3 to 8 weeks after initiating treatment. The course is favorable after withdrawal, with or without corticosteroids. Fever may be the only sign of a drug reaction, resolving with withdrawal and recurring at re-challenge. The underlying mechanism remains unknown. Definitive cure can be achieved by discontinuing hydroxyurea, avoiding the need for further investigations.