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Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient
Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary condition characterized by hypoxemia with progression to respiratory failure, rapid onset of dyspnea, and blood loss anemia. While hemoptysis may be present and corroborates the diagnosis, it is absent in about half of the...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671050/ https://www.ncbi.nlm.nih.gov/pubmed/34926047 http://dx.doi.org/10.7759/cureus.19575 |
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author | Phan, Alexander T Hu, Janie Hasan, Mufadda |
author_facet | Phan, Alexander T Hu, Janie Hasan, Mufadda |
author_sort | Phan, Alexander T |
collection | PubMed |
description | Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary condition characterized by hypoxemia with progression to respiratory failure, rapid onset of dyspnea, and blood loss anemia. While hemoptysis may be present and corroborates the diagnosis, it is absent in about half of the cases, resulting in a diagnostic challenge with variable presenting symptoms. Imaging findings on chest x-ray or computed tomography (CT) scans are also non-specific, often showing diffuse bilateral alveolar opacities. Because DAH is an under-recognized diagnosis, physicians should maintain a degree of clinical suspicion for DAH in patients with unexplained airspace opacities and no signs of an infectious etiology. This is especially important in higher-risk populations such as patients with hematological malignancies, who have a propensity for thrombocytopenia and coagulopathy compounded by the use of anticoagulants. Patients with hematological malignancies, namely acute myeloid leukemia (AML), are also at risk for drug-induced DAH due to the use of cytotoxic medications like cytarabine. Here, we present the case of a 48-year-old male with a past medical history of AML and myeloid sarcoma who developed shortness of breath after receiving cytarabine chemotherapy. Chest radiography revealed diffuse bilateral infiltrates. He was intubated and underwent flexible bronchoscopy, which resulted in a bloody effluent consistent with DAH. After ruling out infectious etiologies, we reached a final diagnosis of DAH and started the patient on corticosteroid therapy. |
format | Online Article Text |
id | pubmed-8671050 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-86710502021-12-16 Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient Phan, Alexander T Hu, Janie Hasan, Mufadda Cureus Internal Medicine Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary condition characterized by hypoxemia with progression to respiratory failure, rapid onset of dyspnea, and blood loss anemia. While hemoptysis may be present and corroborates the diagnosis, it is absent in about half of the cases, resulting in a diagnostic challenge with variable presenting symptoms. Imaging findings on chest x-ray or computed tomography (CT) scans are also non-specific, often showing diffuse bilateral alveolar opacities. Because DAH is an under-recognized diagnosis, physicians should maintain a degree of clinical suspicion for DAH in patients with unexplained airspace opacities and no signs of an infectious etiology. This is especially important in higher-risk populations such as patients with hematological malignancies, who have a propensity for thrombocytopenia and coagulopathy compounded by the use of anticoagulants. Patients with hematological malignancies, namely acute myeloid leukemia (AML), are also at risk for drug-induced DAH due to the use of cytotoxic medications like cytarabine. Here, we present the case of a 48-year-old male with a past medical history of AML and myeloid sarcoma who developed shortness of breath after receiving cytarabine chemotherapy. Chest radiography revealed diffuse bilateral infiltrates. He was intubated and underwent flexible bronchoscopy, which resulted in a bloody effluent consistent with DAH. After ruling out infectious etiologies, we reached a final diagnosis of DAH and started the patient on corticosteroid therapy. Cureus 2021-11-14 /pmc/articles/PMC8671050/ /pubmed/34926047 http://dx.doi.org/10.7759/cureus.19575 Text en Copyright © 2021, Phan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Internal Medicine Phan, Alexander T Hu, Janie Hasan, Mufadda Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title | Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title_full | Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title_fullStr | Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title_full_unstemmed | Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title_short | Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient |
title_sort | diffuse alveolar hemorrhage in the setting of cytarabine therapy in a critically ill patient |
topic | Internal Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671050/ https://www.ncbi.nlm.nih.gov/pubmed/34926047 http://dx.doi.org/10.7759/cureus.19575 |
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