Breathless after brentuximab: Unmasking a rare adverse reaction

Brentuximab Vedotin (BV) is an antibody-drug conjugate used in the treatment of CD30-positive malignancies such as Hodgkins lymphoma.While generally well tolerated, BV has been rarely associated with severe pulmonary toxicity, including pneumonitis.We report the case of a 25-year-old male with relapsed Hodgkins lymphoma who presented with high-grade fever, generalized skin rash, cough, and dyspnea two weeks after receiving BV.The patient rapidly progressed to respiratory failure, necessitating mechanical ventilation and prone positioning for severe acute respiratory distress syndrome (ARDS) .Chest imaging showed bilateral infiltrates and empirical antibiotics were started.After ruling out probable infection and other common causes, corticosteroid therapy was started in suspicion of BV induced pneumonitis.Patient had gradual improvement in oxygenation, subsequently weaned off ventilator and recovered completely.BV-induced pneumonitis is a rare but serious adverse effect.The underlying mechanisms may involve direct cytotoxicity or immune-mediated injury.Diagnosis requires a strong suspicion and exclusion of other etiologies.Management typically includes discontinuation of BV and initiation of corticosteroids and immunosuppressant's.This case underscores the importance of high index of suspicion, early recognition and prompt management of BV-induced pneumonitis.Clinicians should consider this diagnosis in patients presenting with new-onset respiratory symptoms following BV therapy, especially when other causes have been excluded.