Table 1.

Teaching points related to the case

1. Cyclophosphamide, a commonly used alkylating agent for the treatment of ANCA-associated vasculitis, can cause direct lung toxicity

2. Lung damage can manifest as early-onset pneumonitis (likely reversible) or late-onset lung fibrosis (usually irreversible)

3. When considering patients undergoing hemodialysis who present with symptoms and signs of cyclophosphamide-associated lung injury, it is important to first exclude pulmonary infection and edema

4. In patients with a pneumonitis-type picture, as presented here, withdrawal of cyclophosphamide can lead to resolution of symptoms and radiographic evidence of disease

ANCA, antineutrophil cytoplasmic antibody.