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Mankuzhy Gopalakrishnan SS, Raveendran R, Paulraj J, Balaganesan H. Goodpasture syndrome: a rare case presenting with recurrent haemoptysis. BMJ Case Rep 2024; 17:e252666. [PMID: 38171635 PMCID: PMC10773409 DOI: 10.1136/bcr-2022-252666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Goodpasture syndrome is a rare autoimmune disease which affects young adults with a male preponderance and can be triggered at any point in life with a classical clinical triad of rapidly progressive glomerulonephritis, diffuse pulmonary haemorrhage and circulating anti-glomerular basement membrane antibody (anti-GBM antibody). Here we are presenting a case of a young man with hypertension in his early 20s who presented with fatigue, recurrent haemoptysis, breathlessness and decreased urine output without features of infection. He was diagnosed at an early stage of the disease with the help of clinical, serological and radiological findings. An early diagnosis with effective treatment using plasma exchange, intravenous high-dose methylprednisolone, and cyclophosphamide showed a rapid improvement in the patient's condition with an immediate decrease in anti-GBM titres and proteinuria.
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Affiliation(s)
| | - Remya Raveendran
- Radiodiagnosis, Shri Sathya Sai Medical College and Research Institute, Chengalpattu, Tamilnadu, India
| | - Jenikar Paulraj
- Radiodiagnosis, Shri Sathya Sai Medical College and Research Institute, Chengalpattu, Tamilnadu, India
| | - Harshavardhan Balaganesan
- Radiodiagnosis, Shri Sathya Sai Medical College and Research Institute, Chengalpattu, Tamilnadu, India
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2
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Anan K, Kataoka Y, Ichikado K, Kawamura K, Yasuda Y, Hisanaga J, Nitawaki T, Yamamoto Y. Algorithms Identifying Patients With Acute Exacerbation of Interstitial Pneumonia and Acute Interstitial Lung Diseases Developed Using Japanese Administrative Data. Cureus 2024; 16:e53073. [PMID: 38410324 PMCID: PMC10896674 DOI: 10.7759/cureus.53073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND We aimed to develop algorithms to identify patients with acute exacerbation of interstitial pneumonia and acute interstitial lung diseases using Japanese administrative data. METHODS This single-center validation study examined diagnostic algorithm accuracies. We included patients >18 years old with at least one claim that was a candidate for acute exacerbation of interstitial pneumonia, acute interstitial lung diseases, and pulmonary alveolar hemorrhage who were admitted to our hospital between January 2016 and December 2021. Diagnoses of these conditions were confirmed by at least two respiratory physicians through a chart review. The positive predictive value was calculated for the created algorithms. RESULTS Of the 1,109 hospitalizations analyzed, 285 and 243 were for acute exacerbation of interstitial pneumonia and acute interstitial lung diseases, respectively. As there were only five cases of pulmonary alveolar hemorrhage, we decided not to develop an algorithm for it. For acute exacerbation of interstitial pneumonia, acute interstitial lung diseases, and acute exacerbation of interstitial pneumonia or acute interstitial lung diseases, algorithms with high positive predictive value (0.82, 95% confidence interval: 0.76-0.86; 0.82, 0.74-0.88; and 0.89, 0.85-0.92, respectively) and algorithms with slightly inferior positive predictive value but more true positives (0.81, 0.75-0.85; 0.77, 0.71-0.83; and 0.85, 0.82-0.88, respectively) were developed. CONCLUSION We developed algorithms with high positive predictive value for identifying patients with acute exacerbation of interstitial pneumonia and acute interstitial lung diseases, useful for future database studies on such patients using Japanese administrative data.
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Affiliation(s)
- Keisuke Anan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, JPN
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
- Clinical Research Support Section, Saiseikai Kumamoto Hospital, Kumamoto, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group, Osaka, JPN
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group, Osaka, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Kodai Kawamura
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Yuko Yasuda
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Junpei Hisanaga
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Tatsuya Nitawaki
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, JPN
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Bardarov S, Vue C, Santana R, Nfonoyim J. Diffuse Alveolar Hemorrhage Occurring Suddenly in a Diabetic Patient With Asthma Exacerbation. Cureus 2024; 16:e51893. [PMID: 38333472 PMCID: PMC10851031 DOI: 10.7759/cureus.51893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare but potentially life-threatening condition characterized by bleeding into the alveolar spaces of the lungs. DAH can occur due to a wide range of etiologies including autoimmune diseases, infections, drugs, and malignancies. The clinical presentation is variable and may include cough, dyspnea, fever, and hemoptysis. Diagnosis is often challenging due to the nonspecific symptoms and a lack of definitive diagnostic criteria. Treatment is primarily aimed at addressing the underlying cause and providing supportive care.
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Affiliation(s)
- Svetoslav Bardarov
- Pathology and Laboratory Medicine, Richmond University Medical Center, Staten Island, USA
| | - Chong Vue
- Pathology and Laboratory Medicine, Richmond University Medical Center, Staten Island, USA
| | - Rochell Santana
- Pathology and Laboratory Medicine, Richmond University Medical Center, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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Nangrani A, Chung J, Jyang E, Nangrani K, Schmidt M. A Rare Case of Diffuse Alveolar Hemorrhage Caused by Fentanyl Inhalation. Cureus 2023; 15:e47598. [PMID: 38022247 PMCID: PMC10665760 DOI: 10.7759/cureus.47598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening pulmonary disorder characterized by blood accumulation in alveolar spaces, often associated with autoimmune diseases and infections. Drug-induced causes of DAH, including inhalation of substances like fentanyl, are emerging concerns. A 40-year-old male with bipolar disorder and polysubstance abuse presented with altered mental status and hemoptysis after inhaling an unknown substance. Physical examination revealed respiratory distress, pinpoint pupils, and severe hypoxemia. Naloxone administration improved his condition. The workup showed negative infection markers, positive fentanyl-specific urine test, and diffuse bilateral opacities on imaging. Bronchoalveolar lavage confirmed DAH with >20% hemosiderin-laden macrophages. Steroid treatment resulted in marked improvement. Drug-induced DAH, such as fentanyl inhalation, should be considered in patients with altered mental status and pulmonary symptoms following substance use. Comprehensive evaluation and targeted treatment are crucial for optimal outcomes.
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Affiliation(s)
- Aneeta Nangrani
- Pulmonary and Critical Care Medicine, One Brooklyn Health, Brooklyn, USA
| | - Justin Chung
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Edison Jyang
- Internal Medicine, Medical University of Lublin, Lublin, POL
| | - Kunal Nangrani
- Pulmonary and Critical Care Medicine, Mount Sinai Hospital, Queens, USA
| | - Marie Schmidt
- Pulmonary and Critical Care Medicine, Interfaith Medical Center, Brooklyn, USA
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5
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Suess C, Schwartz M, Hausmann R. Pulmonary capillaritis as a cause of lethal diffuse alveolar hemorrhage. Int J Legal Med 2023; 137:1481-1487. [PMID: 37402014 DOI: 10.1007/s00414-023-03056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Lethal pulmonary hemoptysis is a common finding in forensic medicine. Since hemoptysis does not necessarily occur before death and its previous symptoms are usually unspecific, indicative signs or findings at the site of a corpse may be completely absent. If lethal acute alveolar hemorrhage is found in the post-mortem examination, a differential diagnosis should be made for traumatic, substance-related, infectious, or organic causes. Cocaine-associated pulmonary hemorrhage and drug reactions are in the foreground. For organic causes, autoimmune diseases should be considered in addition to cardiac, haematological, and infectious causes. The following two cases show similarities both in the sudden, unexpected deaths and the anamnesis of the two deceased women. One of the deceased received a Corona vaccination a few months earlier. In each case, the post-mortem examination revealed an acute diffuse pulmonary hemorrhage caused by acute inflammation of the lung capillaries. This case presentation demonstrates the necessity of a complete autopsy including toxicological and histological analyses. The documentation and publication of rare causes of death are essential for medical research and practice in order to critically consider and discuss the possibility of to date unknown associations in similar cases.
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Affiliation(s)
- Christine Suess
- Institute of Legal Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland.
| | - Melanie Schwartz
- Institute of Legal Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| | - Roland Hausmann
- Institute of Legal Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
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Mopeli K, Mabaso T, Alli N, Dangor Z, Verwey C. Diffuse alveolar haemorrhage in children hospitalised in a tertiary‑level hospital: A retrospective descriptive study. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.282. [PMID: 37622106 PMCID: PMC10446159 DOI: 10.7196/ajtccm.2023.v29i2.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/03/2023] [Indexed: 08/26/2023] Open
Abstract
Background Diffuse alveolar haemorrhage (DAH) is considered a rare condition in children. There is no consensus on the management of DAH syndromes in Africa or other low- and middle-income countries. In this brief report, the clinical characteristics, management and outcomes of children treated for DAH in the Chris Hani Baragwanath Academic Hospital paediatric pulmonology unit in Johannesburg, South Africa are described. Fifteen children were included in this case series, of whom 11 (73.3%) presented with severe microcytic anaemia. Of the 11 children who had bronchoalveolar lavage, 9 (81.8%; 60.0% of the total) had haemosiderin-laden macrophages on microscopy. Only 5 children had a lung biopsy, of whom 3 (60.0%) had capillaritis. All the children were started on oral prednisone at presentation, and 11 (73.3%) received additional complementary treatment. Nine children (60.0%) had normal haemoglobin levels 1 year after initiation of treatment. Our series supports previous reports that DAH is uncommon in children. A large proportion of our patients responded well to treatment despite some resource limitations. What the study adds The study provides additional data on children presenting with diffuse alveolar haemorrhage in a South African tertiary hospital. What are the implications of the findings There is a need for South African pulmonologists to come together and conduct a national audit of these patients in different hospitals to determine the incidence in our country, as well as to inform a management plan in the presence or absence of specialised tests.
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Affiliation(s)
- K Mopeli
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - T Mabaso
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Alli
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | - Z Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Qanash S, Alamoudi S, Alsuraihi A, Jafri A, Malakah MA, Baghlaf B, Alamoudi M, Althobaiti MM. Lenalidomide-Induced Diffuse Alveolar Hemorrhage in Patient With Multiple Myeloma. Cureus 2023; 15:e43250. [PMID: 37692720 PMCID: PMC10491948 DOI: 10.7759/cureus.43250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
We present a case of multiple myeloma that was treated with a regimen that included lenalidomide. Lenalidomide, a thalidomide analog, is an immunomodulatory drug created synthetically by changing the chemical makeup of thalidomide to increase efficacy and lessen negative effects. It has been authorized for the treatment of relapsed or resistant multiple myeloma. In the case discussed in this report, the patient's lenalidomide dosage was changed to account for her renal impairment. Regardless of this adjustment of the dose, the patient presented with lung infiltrates, hemoptysis, and fever. Unfortunately, she was diagnosed with diffuse alveolar hemorrhage (DAH) secondary to lenalidomide after excluding other causes of hemoptysis. To the best of our knowledge, we believe this is the first case of DAH reported with lenalidomide in Saudi Arabia, which also discusses the possible therapeutic options for such presentations.
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Affiliation(s)
- Sultan Qanash
- Department of Medicine, Ministry of National Guard Health Affairs, Jeddah, SAU
- Department of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Sameer Alamoudi
- Department of Adult Hematology and Blood and Marrow Transplant (BMT), King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Adult Hematology and Blood and Marrow Transplant (BMT), Ministry of National Guard Health Affairs, Jeddah, SAU
- Department of Adult Hematology and Blood and Marrow Transplant (BMT), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Anas Alsuraihi
- Department of Adult Hematology and Blood and Marrow Transplant (BMT), Ministry of National Guard Health Affairs, Jeddah, SAU
- Department of Adult Hematology and Blood and Marrow Transplant (BMT), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Asif Jafri
- Department of Internal Medicine, Ministry of the National Guard Health Affairs, Jeddah, SAU
- Department of Internal Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Manar A Malakah
- Department of Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Bayan Baghlaf
- Department of Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mulukah Alamoudi
- College of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohammad M Althobaiti
- Department of Adult Hematology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
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Kambhatla S, Vipparthy S, Manadan AM. Rheumatic diseases associated with alveolar hemorrhage: analysis of the national inpatient sample. Clin Rheumatol 2023; 42:1177-1183. [PMID: 36396790 PMCID: PMC9672553 DOI: 10.1007/s10067-022-06449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Diffuse alveolar hemorrhage (DAH) is a severe pulmonary complication of numerous diseases, including rheumatic conditions. We have conducted an observational study using inpatient data from the National Inpatient Sample to study the relationship of DAH with rheumatic conditions along with their descriptive characteristics. METHODS An observational study was conducted on hospitalizations in 2016-2018 with a principal diagnosis of DAH from the United States National Inpatient Sample database. A multivariate logistic regression analysis was performed to calculate adjusted odds ratios (ORadj) for risk factors of DAH. RESULTS A total of 5420 DAH hospitalizations were identified among 90 million hospitalizations. Mortality in this group was found to be 24.3%. Majority of patients admitted with DAH were white and male, with a mean age of 61.8 years and a mean LOS of 10.6 days. Multivariate analysis showed that multiple rheumatic diseases were associated with DAH, including anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) (ORadj 72.56) (95% C.I. 50.607-104.043), antiphospholipid antibody syndrome (APLS) (ORadj 6.51) (95% C.I. 3.734-11.366), eosinophilic granulomatosis with polyangiitis (EGPA) (ORadj 7.13) (95% C.I. 1.886-26.926), Goodpasture's (ORadj 30.58) (95% C.I. 16.360-57.176), rheumatoid arthritis (RA) (ORadj 1.60) (95% C.I. 1.158-2.212), sarcoidosis (ORadj 3.99) (95% C.I. 2.300-6.926), and systemic lupus (SLE) (ORadj 5.82) (95% C.I. 3.993-8.481). CONCLUSION Although DAH is a relatively rare entity, it carries a very high mortality. Multiple rheumatic diseases were associated with DAH hospitalizations including AAV, APLS, EGPA, Goodpasture's, RA, sarcoidosis, and SLE. Key points • It is known that DAH carries a high morbidity and mortality based on prior literature. However, large datasets on the association of rheumatic diseases with DAH are lacking • This study identifies the descriptive characteristics of patients admitted to the hospital with DAH • This study also identifies the strength of association of rheumatic diseases with DAH.
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Affiliation(s)
- Soumyasri Kambhatla
- Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Sharath Vipparthy
- Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Augustine M Manadan
- Rheumatology Program Director, Cook County Hospital, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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Nguyen D, Kantarjian HM, Short NJ, Qiao W, Ning J, Cuglievan B, Daver NG, DiNardo CD, Jabbour EJ, Kadia TM, Borthakur G, Garcia-Manero G, Konopleva MY, Andreeff M, Ravandi-Kashani F, Sasaki K, Issa GC. Early mortality in acute myeloid leukemia with KMT2A rearrangement is associated with high risk of bleeding and disseminated intravascular coagulation. Cancer 2023; 129:1856-1865. [PMID: 36892949 DOI: 10.1002/cncr.34728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/25/2022] [Accepted: 10/26/2022] [Indexed: 03/10/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) with rearrangement of lysine methyltransferase 2a gene (KMT2Ar) is characterized by chemotherapy resistance and high rates of relapse. However, additional causes of treatment failure or early mortality have not been well-defined in this entity. METHODS In a retrospective analysis, causes and rates of early mortality following induction treatment were compared between a cohort of adults with KMT2Ar AML (N = 172) and an age-matched cohort of patients with normal karyotype AML (N = 522). RESULTS The 60-day mortality in patients with KMT2Ar AML was 15% compared with 7% with normal karyotype (p = .04). We found a significantly higher occurrence of major bleeding events (p = .005) and total bleeding events (p = .001) in KMT2Ar AML compared with diploid AML. Among evaluable patients with KMT2Ar AML, 93% exhibited overt disseminated intravascular coagulopathy compared with 54% of patients with a normal karyotype before death (p = .03). In a multivariate analysis, KMT2Ar and a monocytic phenotypic were the only independent predictors of any bleeding event in patients who died within 60 days (odds ratio, 3.5; 95% CI, 1.4-10.4; p = .03; odds ratio, 3.2; 95% CI, 1-1-9.4; p = .04, respectively). CONCLUSION In conclusion, early recognition and aggressive management of disseminated intravascular coagulopathy and coagulopathy are important considerations that could mitigate the risk of death during induction treatment in KMT2Ar AML. PLAIN LANGUAGE SUMMARY Acute myeloid leukemia (AML) with rearrangement of KMT2A is characterized by chemotherapy resistance and high rates of relapse. However, additional causes of treatment failure or early mortality have not been well-defined in this entity. In this article, that KMT2A-rearranged AML is demonstrably associated with higher early mortality and an increased risk of bleeding and coagulopathy, specifically, disseminated intravascular coagulation, compared with normal karyotype AML. These findings emphasize the importance of monitoring and mitigating coagulopathy in KMT2A-rearranged leukemia similar to what is done in acute promyelocytic leukemia.
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Affiliation(s)
- Daniel Nguyen
- Department of Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Branko Cuglievan
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naval G Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marina Y Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Andreeff
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi-Kashani
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Boyle N, O'Callaghan M, Ataya A, Gupta N, Keane MP, Murphy DJ, McCarthy C. Pulmonary renal syndrome: a clinical review. Breathe (Sheff) 2022; 18:220208. [PMID: 36865943 PMCID: PMC9973488 DOI: 10.1183/20734735.0208-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023] Open
Abstract
The term "pulmonary renal syndrome" describes a clinical syndrome which is characterised by the presence of both diffuse alveolar haemorrhage and glomerulonephritis. It encompasses a group of diseases with distinctive clinical and radiological manifestations, as well as different pathophysiological processes. The most common diseases implicated are anti-neutrophil cytoplasm antibodies (ANCA)-positive small vessel vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Prompt recognition is required as respiratory failure and end-stage renal failure can rapidly occur. Treatment includes a combination of glucocorticoids, immunosuppression, plasmapheresis and supportive measures. The use of targeted treatments has significantly reduced mortality. Thus, an understanding of pulmonary renal syndrome is essential for the respiratory physician.
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Affiliation(s)
- Niamh Boyle
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Marissa O'Callaghan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michael P. Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - David J. Murphy
- School of Medicine, University College Dublin, Dublin, Ireland,Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland,Corresponding author: Cormac McCarthy ()
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Martin K, Deleveaux S, Cunningham M, Ramaswamy K, Thomas B, Lerma E, Madariaga H. The presentation, etiologies, pathophysiology, and treatment of pulmonary renal syndrome: A review of the literature. Dis Mon 2022; 68:101465. [PMID: 36008166 DOI: 10.1016/j.disamonth.2022.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Pulmonary renal syndrome (PRS) is a constellation of different disorders that cause both rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage. While antineutrophil cytoplasmic antibody associated vasculitis and anti-glomerular basement membrane disease are the predominant causes of PRS, numerous other mechanisms have been shown to cause this syndrome, including thrombotic microangiopathies, drug exposures, and infections, among others. This syndrome has high morbidity and mortality, and early diagnosis and treatment is imperative to improve outcomes. Treatment generally involves glucocorticoids and immunosuppressive agents, but treatment targeted to the underlying disorder can improve outcomes and mitigate side effects. Familiarity with the wide range of possible causes of PRS can aid the clinician in workup, diagnosis and early initiation of treatment. This review provides a summary of the clinical presentation, etiologies, pathophysiology, and treatment of PRS.
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Affiliation(s)
| | | | | | | | - Beje Thomas
- Medstar Georgetown University Hospital, United States
| | - Edgar Lerma
- Advocate Christ Medical Center, United States
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12
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Reibaldi AA, Sager L, Calvo R, Ortiz A, Roverano S, Paira S, Fernández de Carrera E. Diffuse alveolar haemorrhage in systemic lupus erythematosus patients. REUMATOLOGIA CLINICA 2022; 18:84-90. [PMID: 35153041 DOI: 10.1016/j.reumae.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/03/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pulmonary haemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication due to its high mortality. Early treatment benefits the outcome. Reports on predictive factors of PH in SLE patients are scarce. OBJECTIVE To describe a case series of PH in SLE patients that were attended in the Rheumatology Section of the J. M. Cullen Hospital and to compare this data with published results. METHODS Patients with SLE (1982-1997 ACR criteria) and PH diagnosed by clinical criteria (cough, dyspnoea, haemoptysis), haemoglobin below 12 g/dL or drop greater than 2 points, new radiological infiltrate and bronchioalveolar lavage, monitored between June 1987 and December 2019 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analysed. RESULTS From a database of 306 SLE patients, 25 (8.2%) developed 29 episodes of PH. PH was the first manifestation of SLE in 8 patients. Renal involvement was the most frequent manifestation prior to the development of PH. SLE activity (measured by SLEDAI) was high during the episodes (mean: 16.8). Renal failure (p = .027) and mechanical respiratory support (p = .006) were related to mortality (40.7%) with statistical significance. Patients with SLEDAI higher to 10 at SLE onset showed more likelihood of developing PH. The OR was 2.68 (p = .046). CONCLUSIONS Although treatment in SLE has progressed in recent years, PH continues to be a rare and severe complication of this disease. When a PH is suspected, studies to confirm it must be done rapidly, since early diagnosis and aggressive treatment have been shown to improve survival. We observed that patients with renal involvement and mechanical respiratory support had higher mortality than SLE patients without them.
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Affiliation(s)
| | - Lorena Sager
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Romina Calvo
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Alberto Ortiz
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Susana Roverano
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Sergio Paira
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
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13
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Saha BK, Chong WH, Milman NT. Differentiation of idiopathic pulmonary hemosiderosis from rheumatologic and autoimmune diseases causing diffuse alveolar hemorrhage: establishing a diagnostic approach. Clin Rheumatol 2022; 41:325-336. [PMID: 34491458 DOI: 10.1007/s10067-021-05895-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
This narrative review provides an overview of diffuse alveolar hemorrhage (DAH) associated with rheumatologic and autoimmune diseases and their differentiation from idiopathic pulmonary hemosiderosis (IPH). Relevant immunologic diseases associated with DAH are discussed, and a diagnostic flowchart is proposed to establish a "definitive" diagnosis of IPH within the spectrum of DAH. IPH is a rare cause of recurrent DAH both in children and adults. In adults, a definitive diagnosis of IPH requires a lung biopsy and histopathologic examination demonstrating intraalveolar hemorrhage, hemosiderin-laden macrophages, and a variable degree of fibrosis in the absence of both capillaritis and cellular inflammation. The presence of small vessel vasculitis points towards immunologic, well-differentiated, or sometimes undifferentiated rheumatologic diseases. However, it is essential to recognize that many rheumatologic diseases may in the initial phase present with DAH without any evidence of capillaritis, thus mimicking IPH. Although not definitely established, it is likely that immunologic processes are involved in IPH, and we, therefore, suggest the consideration of a more suitable term for the disease, e.g., "Immune-mediated Pulmonary Hemosiderosis" to acknowledge the aberrancy in the immune parameters and a positive response to immunosuppressive therapy.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA.
| | - Woon H Chong
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, 4700, Næstved, Denmark
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14
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Gomes MM, Barros C, Luís H, Bilreiro M, Machado B. Diffuse Alveolar Hemorrhage: An Unexpected Effect After Taking Acetylsalicylic Acid. Cureus 2022; 14:e21486. [PMID: 35223265 PMCID: PMC8859752 DOI: 10.7759/cureus.21486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/05/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare, acute, and life-threatening condition that in most cases is associated with pulmonary-renal syndromes, connective tissue disorders, infections, and drugs. We report a case of a 45-year-old male who developed a diffuse pulmonary hemorrhage after taking 500 mg of acetylsalicylic acid for a month in the context of acute lower back pain. The prolonged use of this acetylsalicylic acid dose led to an increased risk of bleeding. This report describes a rare bleeding site that clinicians should be aware of when managing patients who were exposed to prolonged high dose acetylsalicylic acid.
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15
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Jiménez-Zarazúa O, Vélez-Ramírez LN, Ramírez-Casillas CA, Mondragón JD. Pulmonary thromboembolism and alveolar hemorrhage as initial manifestations of systemic lupus erythematosus. Lupus 2022; 31:116-124. [PMID: 35042383 PMCID: PMC8793315 DOI: 10.1177/09612033211066481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs. SLE can affect the lung, the pulmonary vasculature, and the pleura. A 38-year-old female with limb pain and ecchymosis who later developed pulmonary thromboembolism and alveolar hemorrhage is presented here. Clinical, imaging, laboratory, and histopathological evidence is presented. The patient met the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) criteria for SLE. Furthermore, the patient had a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 35; thus, indicating severe disease. This case is an example of concomitant venous and arterial lung complications in an SLE patient.
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Affiliation(s)
- O Jiménez-Zarazúa
- Hospital General Regional IMSS No. 21, 42581Department of Internal Medicine, León, Guanajuato, Mexico.,Department of Medicine and Nutrition, 10173Universidad de Guanajuato, Guanajuato, Mexico
| | - L N Vélez-Ramírez
- Department of Medicine and Nutrition, 10173Universidad de Guanajuato, Guanajuato, Mexico.,Hospital General de León, Department of Radiology, León, Guanajuato, Mexico
| | - C A Ramírez-Casillas
- Hospital General Regional IMSS No. 21, 42581Department of Internal Medicine, León, Guanajuato, Mexico.,Department of Medicine and Nutrition, 10173Universidad de Guanajuato, Guanajuato, Mexico
| | - J D Mondragón
- Department of Medicine and Nutrition, 10173Universidad de Guanajuato, Guanajuato, Mexico.,Hospital General de León, Department of Radiology, León, Guanajuato, Mexico.,University of Groningen, University Medical Center Groningen, Department of Neurology, The Netherlands.,University of Groningen, University Medical Center Groningen, Alzheimer Center Groningen, The Netherlands
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16
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Chaurasia S, Raghavan R, Thimmappa M. Diffuse alveolar hemorrhage secondary to immune thrombocytopenic purpura: a case report and literature review. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2022. [DOI: 10.4103/jacp.jacp_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Mishra S, Gupta A, Sharma S, Gupta A. Late presentation of lane-hamilton syndrome in a 33 year old female: A case report. Int J Appl Basic Med Res 2022; 12:137-139. [PMID: 35754673 PMCID: PMC9215191 DOI: 10.4103/ijabmr.ijabmr_620_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
Lane-Hamilton syndrome (LHS) is a rare syndromic association between idiopathic pulmonary hemosiderosis and celiac disease (CD). It is usually seen in children below 15 years of age. It can occasionally be seen in adults. We present the case of a 33-year-old female patient who presented with recurrent episodes of hemoptysis to the pulmonary outpatient department. She also gave a history of having frequent loose stools. She was admitted and investigated thoroughly and was found to be suffering from LHS which is a rare disease. High-resolution computed tomography (HRCT) of the chest and duodenal biopsy helped in concluding the diagnosis. She was started on gluten-free diet (GFD) and has responded well with no episodes of hemoptysis on 9-month follow-up and is in good general condition. This case highlights the importance of keeping a high index of suspicion of LHS in a young patient presenting with unexplained hemoptysis and diarrhea. In a known case of CD presenting with hemoptysis, a HRCT chest aids in the diagnosis of LHS. A GFD is the mainstay of long-term treatment, and adherence to this diet shows remarkable improvement in the symptoms of the patient and their overall general condition.
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18
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Park JA. Treatment of Diffuse Alveolar Hemorrhage: Controlling Inflammation and Obtaining Rapid and Effective Hemostasis. Int J Mol Sci 2021; 22:ijms22020793. [PMID: 33466873 PMCID: PMC7830514 DOI: 10.3390/ijms22020793] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or systemic autoimmune disorders. Pathologic findings show pulmonary capillaritis, bland hemorrhage, diffuse alveolar damage, and hemosiderin-laden macrophages, but in the majority of cases, pathogenesis remains unclear. Despite the severity and high mortality, the current treatment options for DAH remain empirical. Systemic treatment to control inflammatory activity including high-dose corticosteroids, cyclophosphamide, and rituximab and supportive care have been applied, but largely unsuccessful in critical cases. Activated recombinant factor VII (FVIIa) can achieve rapid local hemostasis and has been administered either systemically or intrapulmonary for the treatment of DAH. However, there is no randomized controlled study to evaluate the efficacy and safety, and the use of FVIIa for DAH remains open to debate. This review discusses the pathogenesis, diverse etiologies causing DAH, diagnosis, and treatments focusing on hemostasis using FVIIa. In addition, the risks and benefits of the off-label use of FVIIa in pediatric patients will be discussed in detail.
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Affiliation(s)
- Jeong A Park
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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19
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Muharremi S, Poposki A, Kovaceska V, Tozija L, Petrusevska G, Gerasimovska B, Bexheti B, Gjorgjievski N, Janevski Z, Saidi M, Spasovska A, Poposka B, Selim G. A Case of Seronegative Pulmonary-renal Syndrome: Diagnostic and Therapeutic Challenge. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pulmonary renal syndrome (PRS) is not a single entity but is caused by varied etiologies, including anti-neutrophil cytoplasmic antibody (ANCA), associated small vessel vasculitis (such as Wegener’s granulomatosis, microscopic polyangiitis, and Churg-Strauss vasculitis), Goodpasture’s syndrome, systemic lupus erythematosus, Henoch-Schonlein purpura, cryoglobulinemia, and rare causes such as druginduced vasculitis and subacute endocarditis.
CASE REPORT: We report a case of a 51-year-old man who was referred to our hospital with a 2-month history of breathing difficulties, mild hemoptysis, and deteriorated renal function with a serum creatinine of 269 μmol/L. Serological testing was negative for anti-neutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane (GBM) antibody, and also all cultures, including blood and urine, remained negative. In the renal biopsy, not linear deposition of IgG along the GBM and crescents at varying stages with extracapillary glomerulonephritis emphasizes the possibility of a double-seronegative pulmonary renal syndrome. Regarding therapeutic dilemmas, on the 3rd day of hospitalization, we initiated immunosuppression with cyclophosphamide and corticosteroids as well as plasma exchange (5 treatments). Under immunosuppressive therapy and plasma exchange, the patient’s status continually improved; there was no pulmonary bleeding, but the serum creatinine remained high and renal function remained in stage 4 chronic kidney disease. Four weeks later, he was hospitalized again, and we faced a new therapeutic dilemma because of the rapid relapse during immunosuppressive therapy and renal function deterioration that required hemodialysis treatment. Despite repeatedly negative results for anti-GBM and ANCA, initial immunosuppressive therapy with plasma exchange (9 treatments) was included again. The patient was discharged 30 days after admission in a stable general condition, with the maintenance immunosuppressive therapy with mycophenolate mofetil and hemodialysis 3 times/week. After 24 months, we have received information from the hemodialysis center that he is on regular hemodialysis and that he is in good condition.
CONCLUSION: We think that in this atypical case, intensive plasma exchange and immunosuppressive therapy are crucial in the early stage and maintenance therapy is necessary for vasculitis in remission. This reported case has important clinical implications because pulmonary-renal syndrome with negative ANCAs and anti-GBM antibodies is extremely rare and no treatment recommendations have been established yet.
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20
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Kim C, Kim YK, Han J. Radiologic Approach for Pulmonary Vasculitis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:791-807. [PMID: 36238063 PMCID: PMC9514416 DOI: 10.3348/jksr.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
혈관염은 혈관벽의 염증을 특징으로 하는 드문 전신 질환으로 간혹 미만성 폐출혈이나 급성 사구체신염으로 생명을 위협하기도 한다. 원인을 알 수 없는 일차성 혈관염도 있지만 자가면역 질환이나 약물, 감염, 종양 등 수많은 원인들에 의해 발생하는 이차성 혈관염도 있으며 분류가 복잡하고 명확한 진단검사가 없어 진단에 어려움이 있다. 또한 다양하고 비특이적인 증상과 징후 및 검사 소견을 보여 혈관염의 진단에는 임상양상, 영상 검사, 자가항체 검사, 병리 소견 등 여러 가지 결과를 종합하는 것이 필수적이다. 이 종설에서는 혈관염의 분류와 진단에 중요한 증상 및 징후, 특징적으로 폐를 침범하는 대표적인 폐혈관염의 영상 소견과 감별 진단, 그리고 새로운 혈관염 분류를 위한 국제적 연구인 Diagnostic and Classification Criteria in Vasculitis에 대해 소개하고자 한다.
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Affiliation(s)
- Chohee Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Reibaldi AA, Sager L, Calvo R, Ortiz A, Roverano S, Paira S, Fernández de Carrera E. Diffuse Alveolar Haemorrhage in Systemic Lupus Erythematosus Patients. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30226-6. [PMID: 33246912 DOI: 10.1016/j.reuma.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Pulmonary haemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication due to its high mortality. Early treatment benefits the outcome. Reports on predictive factors of PH in SLE patients are scarce. OBJECTIVE To describe a case series of PH in SLE patients that were attended in the Rheumatology Section of the J. M. Cullen Hospital and to compare this data with published results. METHODS Patients with SLE (1982-1997 ACR criteria) and PH diagnosed by clinical criteria (cough, dyspnoea, haemoptysis), haemoglobin below 12 g/dL or drop greater than 2 points, new radiological infiltrate and bronchioalveolar lavage, monitored between June 1987 and December 2019 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analysed. RESULTS From a database of 306 SLE patients, 25 (8.2%) developed 29 episodes of PH. PH was the first manifestation of SLE in 8 patients. Renal involvement was the most frequent manifestation prior to the development of PH. SLE activity (measured by SLEDAI) was high during the episodes (mean: 16.8). Renal failure (p = 0.027) and mechanical respiratory support (p = 0.006) were related to mortality (40.7%) with statistical significance. Patients with SLEDAI higher to 10 at SLE onset showed more likelihood of developing PH. The OR was 2.68 (p = 0.046). CONCLUSIONS Although treatment in SLE has progressed in recent years, PH continues to be a rare and severe complication of this disease. When a PH is suspected, studies to confirm it must be done rapidly, since early diagnosis and aggressive treatment have been shown to improve survival. We observed that patients with renal involvement and mechanical respiratory support had higher mortality than SLE patients without them.
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Affiliation(s)
| | - Lorena Sager
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Romina Calvo
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Alberto Ortiz
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Susana Roverano
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
| | - Sergio Paira
- Sección Reumatología, Hospital José María Cullen, Santa Fe, Argentina
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22
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Logan G, Robalino E, MacIntosh T, Ganti L. Apnea and Diffuse Alveolar Hemorrhage Caused by Cocaine and Heroin Use: A Case Report. Clin Pract Cases Emerg Med 2020; 4:537-539. [PMID: 33217266 PMCID: PMC7676786 DOI: 10.5811/cpcem.2020.7.48438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Drug overdose represents a growing reason for emergency department visits and hospitalizations in the United States. Co-ingestion of multiple substances is also on the rise, and toxidromes can be seen from any of multiple drugs in a single patient. Case Report We present a case of diffuse alveolar hemorrhage secondary to cocaine abuse in a patient who was apneic and unresponsive after heroin overdose. The patient responded to supportive care and was discharged with complete return to physical and mental baseline. Conclusion Clinicians must be vigilant for any number of concomitant toxidromes when a patient is brought in with complications following drug overdose.
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Affiliation(s)
- Gideon Logan
- University of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida
| | - Ernesto Robalino
- University of Central Florida College of Medicine, Department of Internal Medicine, Orlando, Florida
| | - Tracy MacIntosh
- University of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida
| | - Latha Ganti
- University of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida
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Samuel S, Brown B, Mason N, Abdo T. Diffuse alveolar hemorrhage, a rare presentation of polymyositis. Respir Med Case Rep 2020; 31:101261. [PMID: 33145158 PMCID: PMC7593619 DOI: 10.1016/j.rmcr.2020.101261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/15/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background Diffuse alveolar hemorrhage is a medical emergency caused by persistent and recurrent pulmonary hemorrhage [1]. It is an uncommon presentation of polymyositis. Symptoms of polymyositis include fatigue, muscle pains, proximal muscle weakness, and joint pains [2]. Case presentation A 44-year-old male presented with new onset shortness of breath and productive cough with white sputum and occasional hemoptysis. The patient was diagnosed with diffuse alveolar hemorrhage (DAH) via bronchoscopy and discharged initially on prednisone. The patient's laboratory work indicated positive titers of ANA & anti-Jo-1 antibody with low complement levels. These results pointed towards the diagnosis of polymyositis [3]. DAH can also be caused by systemic lupus erythematosus, Goodpasture's syndrome, Sjogren syndrome, anticoagulant therapy, and antiphospholipid antibody syndrome [4]. However, the possibility of these potential causes was excluded. Conclusion This case of diffuse alveolar hemorrhage was most likely due to polymyositis.
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Affiliation(s)
- Sharoon Samuel
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, USA
| | - Brent Brown
- Department of Pulmonary & Critical Care, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Nita Mason
- Department of Radiological Sciences, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Tony Abdo
- Department of Pulmonary & Critical Care, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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Binet Q, Aydin S, Lengele JP, Cambier JF. Lessons for the clinical nephrologist: an uncommon cause of pulmonary-renal syndrome. J Nephrol 2020; 34:935-938. [PMID: 32870493 DOI: 10.1007/s40620-020-00846-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Pulmonary-renal syndrome refers to the combination of elevated plasma creatinine concentration and/or abnormal urinalysis with diffuse alveolar hemorrhage, and involves both an urgent diagnostic approach and care. We report the case of a 24-year-old man presenting with diffuse alveolar hemorrhage as well as a nephritic syndrome associating kidney failure, moderate hypertension, hematuria and selective glomerular proteinuria. The initial high suspicion of anti-glomerular basement membrane (GBM) disease or ANCA-associated vasculitis justified intravenous pulse-corticotherapy in association with plasma exchange. Renal biopsy was remarkable for an IgA nephropathy, lesions of active thrombotic microangiopathy (TMA) and a positive staining for complement factor C4d. Because anti-GBM and ANCA antibodies returned negative, plasma exchange was discontinued, but oral corticosteroids were maintained to prevent alveolar hemorrhage recurrence. In the absence of renal function recovery, hemodialysis was initiated. TMA lesions are frequently seen in IgA nephropathy and are associated with a poorer prognosis. Complement activation seems to be involved in the development of those lesions and contributes to disease progression. Conversely, alveolar hemorrhage in the setting of IgA nephropathy is uncommon. It is thought to result from non-specific mucosal hemorrhage, an immune complex mediated basement membrane damage and an IgA-mediated capillaritis against basement membrane antigens.
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Affiliation(s)
- Quentin Binet
- Department of Nephrology, Grand Hôpital de Charleroi, Gilly, Belgium.
| | - Selda Aydin
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Abstract
Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.
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26
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Zhang L, Liu L, Lin C, Wang X. Early initiation of extracorporeal membrane oxygenation (ECMO) in emergency department to rescue severe diffuse alveolar hemorrhage. Am J Emerg Med 2020; 39:250.e1-250.e3. [PMID: 32811712 DOI: 10.1016/j.ajem.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a serious disease whose main clinical manifestations are hemoptysis and dyspnea. In some cases, invasive mechanical ventilation is ineffective and patients can die quickly. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy that can provide oxygenation support to patients when mechanical ventilation fails. This article reports successful early initiation of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in an emergency department to rescue an adult patient with diffuse alveolar hemorrhage caused by viral pneumonia.
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Affiliation(s)
- Lei Zhang
- Department of Emergency Medicine, Aerospace Center Hospital, Beijing 100049, China
| | - Lina Liu
- Department of Emergency Medicine, Aerospace Center Hospital, Beijing 100049, China
| | - Caiwei Lin
- Department of Emergency Medicine, Aerospace Center Hospital, Beijing 100049, China
| | - Xudong Wang
- Department of Emergency Medicine, Aerospace Center Hospital, Beijing 100049, China.
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Mirouse A, Parrot A, Audigier V, Demoule A, Mayaux J, Géri G, Mariotte E, Bréchot N, de Prost N, Vautier M, Neuville M, Bigé N, de Montmollin E, Cacoub P, Resche-Rigon M, Cadranel J, Saadoun D. Severe diffuse alveolar hemorrhage related to autoimmune disease: a multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:231. [PMID: 32423434 PMCID: PMC7236262 DOI: 10.1186/s13054-020-02936-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening. The objective was to assess characteristics and prognosis factors of DAH who required intensive care unit (ICU) admission in patients with autoimmune diseases. METHODS French multicenter retrospective study including patients presenting DAH related to autoimmune diseases requiring ICU admission from 2000 to 2016. RESULTS One hundred four patients (54% of men) with median age of 56 [32-68] years were included with 79 (76%) systemic vasculitis and 25 (24%) connective tissue disorders. All patients received steroids, and 72 (69%), 12 (11.5%), and 57 (55%) patients had cyclophosphamide, rituximab, and plasma exchanges, respectively. During ICU stay, 52 (50%), 36 (35%), and 55 (53%) patients required mechanical ventilation, vasopressor use, and renal replacement therapy, respectively. Factors associated with mechanical ventilation weaning were age (HR [95%CI] 0.97 [0.96-0.99] per 10 years, p < 0.0001), vasculitis-related DAH (0.52 [0.27-0.98], p = 0.04), and time from dyspnea onset to ICU admission (0.99 [0.99-1] per day, p = 0.03). ICU mortality was 15%. Factors associated with alive status at ICU discharge were chronic cardiac failure (HR [95%CI] 0.37 [0.15-0.94], p = 0.04), antiphospholipid syndrome-related DAH (3.17 [1.89-5.32], p < 0.0001), SAPS II (0.98 [0.97-0.99], p = 0.007), and oxygen flow at ICU admission (0.95 [0.91-0.99] per liter/min, p = 0.04). CONCLUSION DAH in autoimmune diseases is a life-threatening complication which requires mechanical ventilation in half of the cases admitted to ICU.
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Affiliation(s)
- Adrien Mirouse
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,CNRS, FRE3632, 75005, Paris, France.,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Antoine Parrot
- Service de Pneumologie, Hôpital Tenon, APHP, Paris, France
| | - Vincent Audigier
- Département de Biostatistiques, Hôpital Saint-Louis, APHP, Paris, France
| | - Alexandre Demoule
- Service de Réanimation Médicale et Pneumologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Julien Mayaux
- Service de Réanimation Médicale et Pneumologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Guillaume Géri
- Service de Réanimation Médicale, Hôpital Cochin, APHP, Paris, France
| | - Eric Mariotte
- Service de Réanimation Médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Nicolas Bréchot
- Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nicolas de Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, APHP, Créteil, France
| | | | - Mathilde Neuville
- Service de Réanimation Médicale, Hôpital Bichat, APHP, Paris, France
| | - Naïke Bigé
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Etienne de Montmollin
- Service de Réanimation Medico-chirurgicale, Hôpital Delafontaine, Saint-Denis, France
| | - Patrice Cacoub
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France.,INSERM, UMR_S 959, 75013, Paris, France.,CNRS, FRE3632, 75005, Paris, France.,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | | | | | - David Saadoun
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), UPMC Université Paris 06, UMR 7211, Sorbonne Universités, 75005, Paris, France. .,INSERM, UMR_S 959, 75013, Paris, France. .,CNRS, FRE3632, 75005, Paris, France. .,Département de Médecine Interne et Immunologie Clinique, National Center for Autoimmune and Systemic Diseases and National Center for Autoinflammatory Diseases and Amyloidosis, APHP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
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Abstract
Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.
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Alexandre AT, Vale A, Gomes T. Diffuse alveolar hemorrhage: how relevant is etiology? SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:47-52. [PMID: 32476936 DOI: 10.36141/svdld.v36i1.7160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/20/2018] [Indexed: 12/29/2022]
Abstract
Background Diffuse Alveolar Hemorrhage (DAH) is a rare and potentially life-threatening clinical syndrome whose early recognition is essential. Objectives Characterization of patients with DAH and comparison of presentation and evolution of the disease according to etiology. Methods We retrospectively reviewed the clinical records of patients admitted to our hospital over a 7-year period with DAH. Criteria for DAH (1+2): 1 - hemoptysis and/or pulmonary infiltrates and/or anemia (DAH triad); 2 - hemorrhagic bronchoalveolar lavage (BAL) or siderophagic alveolitis. DAH was grouped in immune and nonimmune and the course of disease was compared. Results We included 24 patients admitted with DAH, of which 11 had an immune cause: p-ANCA vasculitis (n=7), Systemic Lupus Erythematosus (n=2), c-ANCA vasculitis (n=1), Rheumatoid Arthritis (n=1) and 13 had a nonimmune cause: heart disease (n=6), amiodarone toxicity (n=2), clotting disorder (n=2), cannabis toxicity (n=1), S. aureus infection (n=1) and idiopathic (n=1). Patients with nonimmune DAH were significantly older than those with immune DAH (67.9±18.1 vs 56.6±18.8 years, p=0.042). DAH triad was observed in 54% of all patients, hemoptysis in 67%, anemia in 79%, and pulmonary infiltrates in all cases. Patients with immune DAH had more frequently pulmonary-renal syndrome (p<0.001), kidney failure (p=0.048), shock (p=0.049) and needed more frequently admition in ICU (p=0.039) and blood transfusion (p=0.043). Hospital length of stay was superior in immune group (29.5±20.0 vs 19.5±14.3 days, p=0.047). In-hospital mortality was exclusive to immune DAH (12.5%). Conclusions Patients with DAH due to immune causes were significantly younger, had more severe presentations of the disease and worst outcomes.
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Affiliation(s)
| | - Artur Vale
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro
| | - Teresa Gomes
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro
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Toolsie O, Tehreem A, Diaz-Fuentes G. Influenza A Pneumonia Associated with Diffuse Alveolar Hemorrhage. A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:592-596. [PMID: 31019189 PMCID: PMC6501731 DOI: 10.12659/ajcr.913801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patient: Female, 80 Final Diagnosis: Diffuse alveolar hemorrhage in influenza A viral pneumonia Symptoms: Generalized fatigue • shortness of breath Medication: — Clinical Procedure: — Specialty: Critical Care Medicine
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Affiliation(s)
- Omesh Toolsie
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Aniqa Tehreem
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Department of Medicine, BronxCare Health System, Bronx, NY, USA
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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31
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Tomos I, Tsilika M, Aggelou E, Karageorgas T, Tsiodras S. An 80-Year-Old Man With Hemoptysis and Unilateral Patchy Opacities. Chest 2018; 154:e135-e138. [PMID: 30409367 DOI: 10.1016/j.chest.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 10/27/2022] Open
Abstract
CASE PRESENTATION An 80-year-old man presented with a 5-day history of hemoptysis, mild shortness of breath on exertion, fatigue, and malaise. He denied chest pain or fever. He had a history of hypertension, congestive heart failure, and left nephrectomy for renal cancer 10 years earlier; he was a former cigarette smoker with a 50 pack-year history, having quit 5 years prior to presentation. The patient did not report any recent travel history or occupational or animal exposures, and he did not have gastroesophageal reflux. Medications included diltiazem hydrochloride, irbesartan, hydrochlorothiazide, and ranitidine.
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Affiliation(s)
- Ioannis Tomos
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Maria Tsilika
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Eleni Aggelou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Theophanis Karageorgas
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Abstract
Cancer continues to be a leading cause of death despite a broader understanding of its biology and the development of novel therapies. Nonetheless, with an increasing survival of this population, intensivists must be aware of the associated emergencies, both old and new. Oncologic emergencies can be seen as an initial presentation of the disease or precipitated by its treatment. In this review, we present key oncologic emergencies that may be encountered in daily practice, complications associated with innovative therapies, and treatment-related adverse events.
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Affiliation(s)
- Krishna Thandra
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zuhair Salah
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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33
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Alveolar hemorrhage associated with cocaine consumption. Heart Lung 2018; 47:525-530. [DOI: 10.1016/j.hrtlng.2018.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 12/30/2022]
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Abstract
Systemic vasculitides frequently affect the pulmonary vasculature. As the signs and symptoms of pulmonary vasculitis are variable and nonspecific, diagnosis and treatment represent a real challenge. Vasculitides should be given consideration, as these diseases present severe manifestations of rapidly progressing pulmonary disease. Examining other organs usually affected by vasculitides (e.g., the skin and kidneys) and determining autoantibody levels are essential to a better management of the disease. A radiological study would also contribute to establishing a diagnosis. The lungs are commonly involved in small-vessel vasculitis, anti-glomerular basement membrane disease, and vasculitides associated with antineutrophil cytoplasmic antibodies. Associated life-threatening diffuse alveolar haemorrhages and irreversible damage to other organs-usually the kidneys-are severe complications that require early diagnosis. Vasculitides are rare diseases that affect multiple organs. An increasing number of treatments-including biological agent-based therapies-requiring cooperation between specialists and centers have become available in the recent years. In the same way, clinicians should be familiar with the complications associated with immunosuppressive therapies.
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Affiliation(s)
| | | | | | | | | | - Luis Valdés
- Interdisciplinary Research Group in Pneumology, Institute of Sanitary Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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35
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Wick MR. Pulmonary disorders that are potentially associated with anti- neutrophilic cytoplasmic antibodies: A brief review. Semin Diagn Pathol 2018; 35:304-314. [PMID: 30173882 DOI: 10.1053/j.semdp.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis frequently manifests with involvement of the lungs and kidneys, and it also may affect other anatomic sites. This article presents the patterns of pulmonary injury in which ANCA-associated vasculitis is included in the differential diagnosis, with a discussion of antineutrophil cytoplasmic antibody testing methods. The histologic features of non-vasculitic, potentially-ANCA-associated pulmonary lesions are reviewed briefly as well.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, Charlottesville, VA, United States.
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36
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Saladi L, Shaikh D, Saad M, Cancio-Rodriguez E, D’Agati VD, Medvedovsky B, Uday KA, Adrish M. Pulmonary renal syndrome: A case report of diffuse alveolar hemorrhage in association with ANCA negative pauci-immune glomerulonephritis. Medicine (Baltimore) 2018; 97:e10954. [PMID: 29879042 PMCID: PMC5999515 DOI: 10.1097/md.0000000000010954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/08/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pulmonary renal syndrome (PRS) is a term most commonly used to describe a combination of glomerulonephritis and pulmonary hemorrhage as a manifestation of a multisystem autoimmune disease. It is usually associated with ANCA vasculitis and anti-GBM disease. Diffuse alveolar hemorrhage in a patient with ANCA and anti-GBM negative pauci-immune glomerulonephritis is rare and optimal management is unknown. PATIENT CONCERNS An 85-year-old man with hypertension, diabetes mellitus, prostate cancer and recently diagnosed pauci-immune necrotizing glomerulonephritis presented to our emergency department with worsening dyspnea and pedal edema for several days. Clinical presentation and radiological studies were suggestive of fluid overload but he developed worsening respiratory failure despite hemodialysis. DIAGNOSES Bronchoscopy confirmed diffuse alveolar hemorrhage. ANCA and anti-GBM antibodies were negative. The patient was diagnosed with pulmonary renal syndrome - diffuse alveolar hemorrhage in the setting of ANCA and anti-GBM negative pauci-immune glomerulonephritis. INTERVENTIONS Patient was started on intravenous pulse steroids, cyclophosphamide and received seven sessions of plasmapheresis. OUTCOMES There was an improvement in patient's respiratory status and repeat bronchoscopy at the end of treatment did not show diffuse alveolar hemorrhage. LESSONS Pauci-immune crescentic necrotizing glomerulonephritis is usually associated with the presence of ANCA, however, ANCA may be absent in 10% of these cases. Immunosuppression is the mainstay of treatment for ANCA and anti-GBM associated PRS. This case highlights the importance of immunosuppression and plasmapheresis in patients with ANCA negative vasculitis due to presence of unidentified serum antibodies. If left untreated, these patients can have a fulminant course with high mortality ranging from 25 to 50%.
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Affiliation(s)
- Lakshmi Saladi
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine, Bronx Care Health System, Bronx, NY
| | | | - Muhammad Saad
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine, Bronx Care Health System, Bronx, NY
| | | | - Vivette D. D’Agati
- Department of Pathology, College of Physicians and Surgeons, Columbia University
| | | | | | - Muhammad Adrish
- Division of Pulmonary and Critical Care Medicine
- Department of Medicine, Bronx Care Health System, Bronx, NY
- Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY
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Long DA, Long B, Koyfman A. Clinical mimics: an emergency medicine focused review of pneumonia mimics. Intern Emerg Med 2018; 13:539-547. [PMID: 29582318 DOI: 10.1007/s11739-018-1840-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Pneumonia is a common cause of morbidity and mortality in adults in the United States. While pneumonia classically presents with a fever, cough, and shortness of breath, the presentation can vary widely in adults. This review evaluates history and physical examination findings of pneumonia and several conditions that mimic pneumonia. Pneumonia is a potentially deadly disease. History and examination findings are variable in pneumonia, and many conditions mimic pneumonia. These conditions include pulmonary embolism, diffuse interstitial lung disease, endocarditis, vasculitis, diffuse alveolar hemorrhage, acute decompensated heart failure, tuberculosis, lung cancer, and acute respiratory distress syndrome. Emergency clinicians should assess the patient while resuscitation occurs. Early antibiotics and the diagnosis of pneumonia can improve outcomes. Key historical and physical examination findings may lead the clinician to consider other conditions that require immediate management. Using clinical evaluation and adjunctive imaging, these conditions can be diagnosed and treated. Knowledge of pneumonia mimics is vital for the care of patients with respiratory complaints. Pneumonia is common and may be deadly, and emergency clinicians must differentiate conditions that mimic pneumonia. Rapid evaluation and management may alleviate morbidity and mortality for each of these conditions. The history and physical examination, in addition to utilizing imaging modalities such as ultrasound and computed tomography, are vital in diagnosis of pneumonia mimics.
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Affiliation(s)
- Drew Alan Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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38
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Underner M, Perriot J, Wallaert B, Peiffer G, Meurice JC, Jaafari N. Hémorragies intra-alvéolaires et consommation de cocaïne. Rev Mal Respir 2018; 35:134-148. [PMID: 29459175 DOI: 10.1016/j.rmr.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/08/2017] [Indexed: 02/05/2023]
Affiliation(s)
- M Underner
- Unité de recherche clinique intersectorielle en psychiatrie, consultation de tabacologie, centre hospitalier Henri-Laborit, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France.
| | - J Perriot
- Dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - B Wallaert
- Service de pneumologie et immunoallergologie, centre de compétence maladies pulmonaires rares, hôpital Calmette, CHU de Lille, 59037 Lille, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J-C Meurice
- Service de pneumologie, CHU La Milétrie, 86021 Poitiers, France
| | - N Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie, consultation de tabacologie, centre hospitalier Henri-Laborit, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France
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Suh JH, Lee BS, Baek SJ, Park SK, Cho EJ. A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.1.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Bum-sik Lee
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Soon Ju Baek
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Soo Kyung Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Jung Cho
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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40
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A fatal case of diffuse alveolar hemorrhage as the initial presentation of systemic lupus erythematosus: A case report and literature review. Respir Med Case Rep 2018; 24:55-57. [PMID: 29977760 PMCID: PMC6010613 DOI: 10.1016/j.rmcr.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 02/04/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare fatal pulmonary complication of systemic lupus erythematosus (SLE). The clinical syndrome is characterized by hemoptysis, acute fall in hematocrit, hypoxemic respiratory failure, and diffuses pulmonary infiltrates. We describe a case of 23-year-old female who presented with Ludwig's angina that was complicated by diffuse alveolar hemorrhage as the initial presentation of undiagnosed systemic lupus erythematosus. A high index of suspicion is need for prompt diagnosis and treatment in order to avoid the high mortality associated with such cases.
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41
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Mara-Koosham G, Stoltze K, Aday J, Rendon P. Pulmonary Renal Syndrome After Streptococcal Pharyngitis: A Case Report. J Investig Med High Impact Case Rep 2016; 4:2324709616646127. [PMID: 27231692 PMCID: PMC4871206 DOI: 10.1177/2324709616646127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/16/2022] Open
Abstract
Pulmonary renal syndrome is a class of small vessel vasculitides that are characterized by the dual presentation of diffuse alveolar hemorrhage (DAH) and glomerulonephritis. Pulmonary renal syndrome has multiple etiologies, but its development has been rarely reported following infection with group A streptococcus. We present the case of a 36-year-old Native American male who was transferred to our facility due to refractory hypoxic respiratory failure. He had been diagnosed with streptococcal pharyngitis 2 weeks prior to admission. Given the presence of hemoptysis, bronchoscopy was performed and was consistent with DAH. Urinalysis demonstrated hematuria and proteinuria, in the setting of elevated creatinine and blood urea nitrogen. Additionally, antistreptolysin O titer was positive. Given the constellation of laboratory findings and history of streptococcal pharyngitis, the patient was diagnosed with PRS secondary to streptococcal infection. High-dose methylprednisolone was initiated with concomitant plasmapheresis. He was extubated successfully after his respiratory status improved and was eventually discharged home after making a full recovery within 2 weeks after admission. This case illustrates the importance of clinically relevant sequelae of streptococcal infection as well as the appropriate treatment of PRS secondary to streptococcal pharyngitis with plasmapheresis and intravenous corticosteroids.
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Pulmonary Leptospirosis With Diffuse Alveolar Hemorrhage: High-Resolution Computed Tomographic Findings in 16 Patients. J Comput Assist Tomogr 2016; 40:91-5. [PMID: 26418542 DOI: 10.1097/rct.0000000000000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the high-resolution computed tomographic (HRCT) findings from patients with leptospirosis and diffuse alveolar hemorrhage (DAH). MATERIALS AND METHODS We retrospectively reviewed HRCT findings from 16 patients diagnosed as having leptospirosis causing DAH. The patient sample was composed of 13 men and 3 women aged 22 to 53 years (mean age, 34.5 years). Diagnosis was established with confirmation of leptospirosis infection by serologic microagglutination test. Histopathological study was performed in 8 patients. Two chest radiologists analyzed the HRCT images and reached decisions by consensus. RESULTS The predominant HRCT findings were ground-glass opacities and airspace nodules (both n = 12, 75%), ground-glass nodules (n = 9, 56.25%), consolidations (n = 7, 43.75%), "crazy-paving" pattern (n = 3, 18.75%), and interlobular septal thickening without ground-glass opacity (n = 3, 18.75%). Bilateral pleural effusion was an associated finding in 2 (12.5%) patients. Analysis of the axial distribution of the lesions revealed diffuse distribution in 11 (68.75%) patients and peripheral lung zone predominance in 5 (31.25%) patients. Abnormalities were bilateral in all 16 (100%) patients. Analysis of the craniocaudal distribution of the lesions revealed lower zone predominance in 9 (56.25%) patients, diffuse distribution in 5 (31.25%) patients, middle zone predominance in 1 (6.25%) patient, and upper zone predominance in 1 (6.25%) patient. CONCLUSIONS The most frequent HRCT findings in patients with leptospirosis causing DAH were ground-glass opacities, airspace nodules, ground-glass nodules, and consolidations. The lesions showed symmetrical distribution with lower zone predominance in most cases.
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Park JA. Diffuse alveolar hemorrhage and recombinant factor VIIa treatment in pediatric patients. KOREAN JOURNAL OF PEDIATRICS 2016; 59:105-13. [PMID: 27186216 PMCID: PMC4865620 DOI: 10.3345/kjp.2016.59.3.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/12/2015] [Accepted: 07/07/2015] [Indexed: 01/13/2023]
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are few data on its use in pediatric patients. The current literature in the PubMed database was reviewed to evaluate the efficacy and risk of rFVIIa treatment for DAH in pediatric patients. This review discusses the diagnosis and treatment of DAH, as well as a new treatment paradigm that includes rFVIIa. Additionally, the risks and benefits of off-label use of rFVIIa in pediatric patients are discussed.
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Affiliation(s)
- Jeong A Park
- Department of Pediatrics, Inje University Haeundae-Paik Hospital, Inje University College of Medicine, Busan, Korea
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Abstract
Interleukin-33 (IL-33) is a member of the IL-1 cytokine superfamily that potently drives production of a variety of cytokines and contributes to the pathogenesis of inflammatory diseases. The IL-33 is a nuclear protein and is released from apoptotic or necrotic cells. Serum IL-33 levels are increased in various diseases, such as atopic dermatitis, chronic hepatitis C infection, and asthma. Here, we show that red blood cells (RBCs) are one of the major sources of plasma IL-33. The IL-33 levels are significantly increased in supernatants from lysed RBCs. Plasma IL-33 levels are increased in patients during hemolysis, and plasma IL-33 levels show a positive correlation with degree of hemolysis. The IL-33 protein and messenger RNA levels were detected in the late stages of differentiation in ex vivo primary human erythroid progenitor cell cultures, suggesting that IL-33 is expressed during maturation of RBCs. Furthermore, hemoglobin depleted red cell lysates induced IL-8 expression in human epithelial cells. This effect was attenuated in IL-33 decoy receptor expressing cells and was enhanced in IL-33 receptor expressing cells. These results suggest that erythroid progenitor cells produce IL-33 and circulating RBCs represent a major source of IL-33 that is released upon hemolysis.
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Rajagopala S, Parameswaran S, Ajmera JS, Ganesh RN, Katrevula A. Diffuse alveolar hemorrhage in IgA nephropathy: case series and systematic review of the literature. Int J Rheum Dis 2016; 20:109-121. [PMID: 26845236 DOI: 10.1111/1756-185x.12818] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the spectrum of pulmonary involvement in immunoglobulin A nephropathy (IgAN). METHODS We describe two patients with pulmonary renal syndrome related to IgAN and a systematic review of previously reported cases of IgAN and lung involvement. RESULTS We identified 23 reports of IgAN-related pulmonary disease, including 19 reports of alveolar hemorrhage and two cases of organizing pneumonia. Dyspnea (84%), hemoptysis (74%), cough (53%) and fever (47%) were common presenting complaints. Simultaneous involvement of kidneys and lung was the most common presentation (42%) but alveolar hemorrhage occurred independent of renal disease in one-fifth (21%). Azotemia was seen in 55.5% at presentation. Mesangio-proliferative glomerulonephritis was the most common biopsy finding and crescentic glomerulonephritis was seen in 27.7%. Among patients undergoing lung biopsy, capillaritis was seen in 72.7%; 37.5% of these had IgA deposits. Steroids with cyclophosphamide, followed by maintenance with methotrexate or azathioprine was used in 44%. Mechanical ventilation, dialysis and plasmapheresis were other adjunctive therapies used. IgAN-related alveolar hemorrhage was associated with a mortality of 26.3% and significant morbidity, with 52.7% having end-stage kidney disease despite immunosuppression. Organizing pneumonia with pulmonary IgA deposition is a well-described association of IgAN. CONCLUSION These findings are similar to our previous observations of Henoch-Schonlein purpura (HSP)-related alveolar hemorrhage, highlighting the similarities of these related syndromes. Multicentric studies of IgAN and HSP-related pulmonary renal syndrome with a standard protocol are needed to define their similarities and differences, optimum suppression and its role in preventing renal progression in this setting.
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Affiliation(s)
- Srinivas Rajagopala
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Jail Singh Ajmera
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Anudeep Katrevula
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
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Dalpiaz G, Piolanti M. Non-infectious Parenchymal Lung Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7121959 DOI: 10.1007/174_2016_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute dyspnea is a common presenting complaint in the emergency room, emergency medicine and intensive care. It may have a cardiovascular or a non-cardiovascular origin, the latter including pulmonary parenchymal diseases. Depending on the cause, it may be associated with fever, cough, hemoptysis, and/or chest pain, with a duration of symptoms that can range from hours to days. Prompt identification of the underlying cause of acute dyspnea is essential in guiding appropriate therapy and management, as patients may rapidly progress to acute respiratory failure. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities, which may require further assessment with computed tomography (HRCT). Acute non-infectious parenchymal lung diseases are often overlooked and may be under-diagnosed. Their diagnosis requires the evaluation, along with the HRCT pattern, of the clinical and laboratory features and of the bronchoalveolar lavage. Biopsy may be necessary in more complex cases. Although the most frequent cause of diffuse non-infectious parenchymal lung involvement is acute hydrostatic pulmonary edema, there is a wide variety of diseases that may be encountered, including acute drug toxicity, hypersensitivity pneumonitis (HP), acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage (DAH). In trauma patients, fat embolism syndrome (FES) must be taken into account. Acute respiratory failure is an eventuality that can occur during the course of chronic lung diseases (UIP for example), which may have been unknown until then.
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Rajagopala S, Sagar BKP, Thabah MM, Srinivas BH, Venkateswaran R, Parameswaran S. Pulmonary-renal syndromes: Experience from an Indian Intensive Care Unit. Indian J Crit Care Med 2015. [PMID: 26195857 PMCID: PMC4478672 DOI: 10.4103/0972-5229.158261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The etiology of patients presenting with pulmonary-renal syndrome (PRS) to Intensive Care Units (ICUs) in India is not previously reported. AIMS The aim was to describe the prevalence, etiology, clinical manifestations, and outcomes of PRS in an Indian ICU and identify variables that differentiate immunologic causes of PRS from tropical syndromes presenting with PRS. MATERIALS AND METHODS We conducted a prospective observational study of all patients presenting with PRS over 1-year. Clinical characteristics of patients with "definite PRS" were compared with those with "PRS mimics". RESULTS We saw 27 patients with "provisional PRS" over the said duration; this included 13 patients with "definite PRS" and 14 with "PRS mimics". The clinical symptoms were similar, but patients with PRS were younger and presented with longer symptom duration. Ninety-two percent of the PRS cohort required mechanical ventilation, 77% required vasopressors and 61.5% required dialysis within 48 h of ICU admission. The etiologic diagnosis of PRS was made after ICU admission in 61.5%. Systemic lupus erythrematosus (54%) was the most common diagnosis. A combination of biopsy and serology was needed in the majority (69%, 9/13). Pulse methylprednisolone (92%) and cyclophosphamide (61.5%) was the most common protocol employed. Patients with PRS had more alveolar hemorrhage, hypoxemia and higher mortality (69%) when compared to "PRS mimics". CONCLUSION The spectrum of PRS is different in the tropics and tropical syndromes presenting with PRS are not uncommon. Multicentric studies are needed to further characterize the burden, etiology, treatment protocols, and outcomes of PRS in India.
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Affiliation(s)
- Srinivas Rajagopala
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
| | - Baburao Kanthamani Pramod Sagar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
| | - Molly Mary Thabah
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
| | - B H Srinivas
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
| | - Ramanathan Venkateswaran
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India
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Sogomonian R, Alkhawam H, Gandhi V, Zaiem F, Moradoghli Haftevani EA, McGarry T. Refractile foreign material deposits and alveolar hemorrhage in crack cocaine smoker. Respir Med Case Rep 2015; 16:48-50. [PMID: 26744653 PMCID: PMC4681965 DOI: 10.1016/j.rmcr.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
Recreational use of alkaloid free-base cocaine, also known as crack cocaine, has reached epidemic proportions in the United States. Inhalation of crack cocaine is known to cause a variety of pulmonary complications. Herein we present a case of diffuse alveolar hemorrhage (DAH) and particulate foreign matter deposition in the setting of crack cocaine inhalation.
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Affiliation(s)
- Robert Sogomonian
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
| | - Hassan Alkhawam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
| | - Viral Gandhi
- Division of Pulmonary and Critical care Medicine, Allegheny General Hospital, USA
| | - Feras Zaiem
- Mayo Evidence Based Practice Center-Mayo Clinic, Rochester, MN, USA
| | | | - Terence McGarry
- Department of Pulmonary/Critical Care, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
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49
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Goodpasture's syndrome: A clinical update. Autoimmun Rev 2015; 14:246-53. [DOI: 10.1016/j.autrev.2014.11.006] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/09/2014] [Indexed: 11/22/2022]
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50
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Abstract
Pulmonary vasculitis encompasses inflammation in the pulmonary vasculature with involved vessels varying in caliber from large elastic arteries to capillaries. Small pulmonary capillaries are the vessels most commonly involved in vasculitis affecting the lung. The antineutrophil cytoplasmic antibody-associated vasculitides, which include granulomatosis with polyangiitis (formerly Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), are the small vessel vasculitides in which pulmonary vasculitis is most frequently observed and are the major focus of this review. Vasculitic involvement of the large pulmonary vessels as may occur in Behçet syndrome and Takayasu arteritis is also discussed.
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Affiliation(s)
- Lindsay Lally
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Robert F Spiera
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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