1
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Zhang Y, Mayor K, Mahdi A. ANCA negative pulmonary vasculitis: a challenging diagnosis. BMJ Case Rep 2024; 17:e258766. [PMID: 38901853 DOI: 10.1136/bcr-2023-258766] [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: 06/22/2024] Open
Abstract
A man in his 40s with end-stage kidney disease due to IgA nephropathy and receiving peritoneal dialysis presented with a 1-week history of breathlessness, cough and nosebleeds. CT scan of the chest revealed ground glass changes while blood tests indicated elevated inflammatory markers and a negative vasculitis screen. This included negative ANCA and anti-GBM antibodies. Initial treatment for suspected atypical pneumonia with antibiotics yielded no clinical improvement.Over the course of the admission, his symptoms progressively worsened, leading to oxygen dependency with a FiO2 of 40% and episodes of haemoptysis. Suspicions of pulmonary vasculitis arose due to clinical deterioration, prompting consultation with a tertiary vasculitis centre. It was subsequently concluded that the clinical and radiological findings correlated with ANCA-negative pulmonary vasculitis or a rare case of IgA-associated pulmonary capillaritis. Treatment with methylprednisolone and rituximab led to significant improvement, allowing rapid oxygen withdrawal. The patient was discharged with a tapering prednisolone regimen.
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Affiliation(s)
- Yimeng Zhang
- Renal Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kara Mayor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amar Mahdi
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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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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3
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Behera TR, Kaur A, Acharya S, Mallick P, Sahu A. Unilateral Diffuse Alveolar Hemorrhage as an Initial Presentation of Microscopic Polyangiitis. Cureus 2023; 15:e46813. [PMID: 37954826 PMCID: PMC10636509 DOI: 10.7759/cureus.46813] [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: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening condition due to widespread damage to small pulmonary vessels commonly caused by systemic vasculitis. Alveolar involvement is typically multi-lobar and bilateral. It frequently presents as bilateral diffuse airspace opacities on chest imaging. Unilateral DAH is rare. Patients presenting with hemoptysis, anemia, hypoxemia, progressive dyspnea, and opacities on chest imaging should be evaluated for systemic vasculitis such as antineutrophilic cytoplasmic antibody (ANCA) vasculitis. We report the case of a 23-year-old female who presented with hemoptysis, severe dyspnea, hypoxemia, anemia, and oliguria. The laboratory exam results showed the patient to be p-ANCA positive, which suggests a diagnosis of microscopic polyangiitis. Chest X-ray showed unilateral airspace opacities, and DAH was confirmed by hemosiderin-laden macrophages on bronchoalveolar fluid histopathological examination. After treatment with plasmapheresis, intravenous methylprednisolone pulse, and cyclophosphamide, the patient's symptoms and radiographic findings improved.
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Affiliation(s)
- Tapas Ranjan Behera
- Nephrology, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND
| | | | | | - Prabhat Mallick
- Nephrology, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND
| | - Alisha Sahu
- Anesthesiology, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND
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4
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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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5
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Rajarajan AP, Shaji A, Sethi J, Sekar A, Nada R, Kohli HS. Pulmonary Renal Syndrome due to Atypical HUS in a Young Gentleman. Indian J Nephrol 2023; 33:313-314. [PMID: 37781545 PMCID: PMC10503574 DOI: 10.4103/ijn.ijn_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 10/03/2023] Open
Affiliation(s)
- Arun P. Rajarajan
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alan Shaji
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmine Sethi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aravind Sekar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harbir S. Kohli
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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6
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Kim TG, Kang J, Seo WJ, Kang J, Park S, Koo H, Park HK, Lee S, Kim JG, Kang HK. Unilateral diffuse alveolar haemorrhage with microscopic polyangiitis: A case report. Respirol Case Rep 2023; 11:e01097. [PMID: 36776995 PMCID: PMC9905055 DOI: 10.1002/rcr2.1097] [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: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Diffuse alveolar haemorrhage (DAH) is a life-threatening condition caused by widespread damage to the small pulmonary vessels. Common chest imaging findings in patients with DAH show bilateral diffuse airspace opacities. DAH complicating antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, including microscopic polyangiitis, should be considered as a differential diagnosis in patients with progressive dyspnea, reduced haemoglobin levels, and alveolar opacities on chest imaging. We report the case of a 78-year-old woman who presented with unilateral DAH, severe dyspnea, and anaemia. DAH was confirmed using bronchoalveolar lavage. Laboratory test results, including ANCA, positive anti-myeloperoxidase antibody, and negative anti-proteinase 3, led to a diagnosis of microscopic polyangiitis. Rituximab and methylprednisolone were administered. The patient's symptoms, laboratory test results, and chest radiography findings improved after the initiation of treatment. This case highlights the importance of prompt recognition of clinical symptoms and signs, including dyspnea and anaemia, for the diagnosis of DAH.
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Affiliation(s)
- Tae Gyoung Kim
- Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Woo Jung Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Jieun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - So‐Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Hyeon‐Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Sung‐Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Jung Gon Kim
- Division of Rheumatology, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
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7
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Da Silva RC, Adhikari P. Granulomatosis With Polyangiitis Presenting With Diffuse Alveolar Hemorrhage: A Systematic Review. Cureus 2022; 14:e29909. [DOI: 10.7759/cureus.29909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
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8
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Ogoshi T, Fukunaga M, Suzuki Y, Taura Y, Yatera K. Percutaneous Left Atrial Appendage Closure in a Patient with Diffuse Alveolar Hemorrhaging Associated with Anticoagulant Therapy and Atrial Fibrillation. Intern Med 2022; 61:2045-2050. [PMID: 34840230 PMCID: PMC9334249 DOI: 10.2169/internalmedicine.8551-21] [Citation(s) in RCA: 1] [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] [Indexed: 11/10/2022] Open
Abstract
Diffuse alveolar hemorrhaging (DAH) due to oral anticoagulation (OAC) is a life-threatening condition that leads to severe respiratory failure. There is a clinical dilemma in that OAC-induced DAH often forces the discontinuation of OAC therapy and the administration of high-dose corticosteroids, which increases the risk of stroke and cardiovascular events. We herein report the first case of OAC-induced DAH and atrial fibrillation (AF) in a patient who completely discontinued OAC therapy and high-dose corticosteroids after experiencing percutaneous left atrial appendage (LAA) occlusion. This case suggests that percutaneous LAA closure may aid in the management of OAC-induced DAH and AF.
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Affiliation(s)
- Takaaki Ogoshi
- Department of Respiratory, Kokura Memorial Hospital, Japan
| | - Masato Fukunaga
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Japan
| | - Yu Suzuki
- Department of Respiratory, Kokura Memorial Hospital, Japan
| | - Yusuke Taura
- Department of Respiratory, Kokura Memorial Hospital, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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9
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Hu Z, Feng X, Zhang B, Huang J. Rare cause of diffuse alveolar haemorrhage and subconjunctival haemorrhage rescued by extracorporeal membrane oxygenation and rituximab. BMJ Case Rep 2022; 15:e250025. [PMID: 35750426 PMCID: PMC9234909 DOI: 10.1136/bcr-2022-250025] [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] [Accepted: 06/16/2022] [Indexed: 11/03/2022] Open
Abstract
A previously healthy man in his 20s presented with acute respiratory distress syndrome and subconjunctival haemorrhage. Imaging was indicative of pervasive pulmonary haemorrhage. There was no evidence of renal involvement. The patient rapidly deteriorated with aggravating respiratory failure regardless of invasive mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This maintained the patient adequate time to allow aggressive therapy. Skin biopsy indicated leucocytoclastic vasculitis. Given that the patient was C-antinuclear cytoplasmic autoantibody (ANCA) positive, pulse dose steroids and rituximab were initiated for the suspicion of ANCA-associated vasculitis (AAV) which resulted in improvement of airspace disease and subconjunctival haemorrhage. Only a few cases reported successful use of ECMO in severe diffuse alveolar haemorrhage (DAH) due to AAV, but no case was in DAH combined with subconjunctival haemorrhage. The need for systemic anticoagulation with pre-existing haemorrhage is still a challenging dilemma.
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Affiliation(s)
- Zaiying Hu
- Department of Rheumatology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoxue Feng
- Department of Rheumatology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baiyu Zhang
- Department of Rheumatology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jianlin Huang
- Department of Rheumatology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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10
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Liang W, Greven J, Fragoulis A, Horst K, Bläsius F, Wruck C, Pufe T, Kobbe P, Hildebrand F, Lichte P. Sulforaphane-Dependent Up-Regulation of NRF2 Activity Alleviates Both Systemic Inflammatory Response and Lung Injury After Hemorrhagic Shock/Resuscitation in Mice. Shock 2022; 57:221-229. [PMID: 34559743 DOI: 10.1097/shk.0000000000001859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hemorrhagic shock/resuscitation (HS/R) is closely associated with overwhelming oxidative stress and systemic inflammation. As an effective activator of the nuclear factor-erythroid factor 2 related factor 2 (Nrf2) pathway, sulforaphane (SFN) exerts antioxidant and anti-inflammatory effects. We explored SFN's effects on alveolar macrophages (AMs), systemic inflammation, and pulmonary damage in an isolated murine HS/R model. Male C57/BL6 wild type and transgenic antioxidant response element (ARE)-luciferase (luc) mice (both n = 6 per group) were exposed to either pressure-controlled HS/R (mean arterial pressure 35-45 mm Hg for 90 min) or sham procedure (surgery without HS/R) or were sacrificed without intervention (control group). Fluid resuscitation was performed via the reinfusion of withdrawn blood and 0.9% saline. Sulforaphane or 0.9% saline (vehicle) was administrated intraperitoneally. Mice were sacrificed 6, 24, or 72 h after resuscitation. Bioluminescence imaging of ARE-luc mice was conducted to measure pulmonary Nrf2 activity. Plasma was collected to determine systemic cytokine levels. Alveolar macrophages were isolated before measuring cytokines in the supernatant and performing immunofluorescence staining, as well as Western blot for intracellular Nrf2. Histological damage was assessed via the acute lung injury score and wet/dry ratio.Hemorrhagic shock/resuscitation was associated with pulmonary Nrf2 activation. Sulforaphane enhanced pulmonary Nrf2 activity and the Nrf2 activation of AM, while it decreased lung damage. Sulforaphane exerted down-regulatory effects on AM-generated and systemic pro-inflammatory mediators, while it did not have such effects on IL-10.In conclusion, SFN beneficially enhances pulmonary Nrf2 activity and promotes Nrf2 accumulation in AMs' nuclei. This may exert not only local protective effects but also systemic effects via the down-regulation of pro-inflammatory cytokines. The administration of Nrf2 activator post-HS/R may represent an innovative treatment strategy.
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Affiliation(s)
- Weiqiang Liang
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan City, Shandong Province, PR China
| | - Johannes Greven
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Athanassios Fragoulis
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, Aachen, Germany
| | - Klemens Horst
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix Bläsius
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Christoph Wruck
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Lichte
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
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11
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Kostelníková P, Skácelová M, Špíšek M, Šimíček M, Horák P. Diffuse alveolar hemorrhage as a life threatening manifestation of newly diagnosed granulomatosis with polyangiitis following COVID-19 infection - a case report. VNITRNI LEKARSTVI 2022; 68:290-294. [PMID: 36283819 DOI: 10.36290/vnl.2022.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A case report of a patient with newly diagnosed granulomatosis with polyangiitis (GPA) after undergoing COVID-19 (Coronavirus Disease 2019) is discussed. GPA is one of the ANCA-associated vasculitis, which is characterized by the presence of autoantibodies against cytoplasmic enzymes neutrophils (Anti Neutrophil Cytoplasmatic Antibodies). It is a vasculitis that mainly affects small blood vessels, leading to damage to the kidneys, lungs, and upper respiratory tract, including the paranasal sinuses and orbits. This disease can result in an acute life-threatening condition. Such complications include diffuse alveolar hemorrhage (DAH), a condition characterized by blood leakage from the pulmonary vessels into the alveoli, often leading to acute vital signs and even respiratory failure. DAH can have many causes - autoimmune diseases including vasculitides as well as non-immunological causes. Early and adequate comprehensive therapy including immunosuppressive treatment (cyclophosphamide/rituximab and glucocorticoids) can be life-saving.
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12
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Liu Y, Zhang QL, Liu HJ, Wang W, Zhou Y, Xu P. Successful treatment of a patient with diffuse alveolar hemorrhage and anti-neutrophil cytoplasmic antibody-associated vasculitis. World J Emerg Med 2022; 13:245-247. [PMID: 35646202 PMCID: PMC9108911 DOI: 10.5847/wjem.j.1920-8642.2022.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/18/2022] [Indexed: 09/17/2023] Open
Affiliation(s)
- Yao Liu
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qiu-ling Zhang
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Heng-jun Liu
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Wei Wang
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yi Zhou
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Peng Xu
- Emergency Department of Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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13
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Wang L, Wang J, Xu Y, Jiao J, Xie L, Mo G. A novel therapeutic strategy using extracorporeal membrane oxygenation in patients with anti-neutrophil cytoplasmic antibodies-associated vasculitis: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1267. [PMID: 34532404 PMCID: PMC8421983 DOI: 10.21037/atm-21-3133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
Diffuse alveolar hemorrhage (DAH) secondary to anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) often results in severe respiratory failure which requires emergent management. In patients who are resistant to traditional mechanical respiratory support, extracorporeal membrane oxygenation (ECMO) can be used to maintain gas exchange, thereby providing time for the administration of immunosuppressive therapy to control the inflammation. Herein, we report the application of ECMO to support an adult patient with AAV complicated by severe respiratory failure due to DAH. Similar cases in the literature were identified and discussed. The patient in our case study was successfully treated with ECMO in the acute phase and relieved by immunosuppressive therapy after withdrawal of ECMO. A search in the PubMed database revealed 32 similar cases with DAH, of which 11 cases were microscopic polyangiitis (MPA), 2 cases were eosinophilic granulomatosis with polyangiitis (EGPA), and 19 cases were granulomatosis with polyangiitis (GPA). These patients were all treated with ECMO. Therefore, to date, we identified 33 patients who were effectively treated with ECMO, including 13 (39.4%) males and 20 (60.6%) females, with a ratio of 1:1.54. The average age was 32.4±17.5 and 36.0±16.1 years for males and females, respectively (t=0.610, P=0.547). Most patients received ECMO on the first day of admission to the intensive care unit (ICU) and it appeared that early initiation of ECMO was associated with a shorter duration of ECMO. In general, complications of ECMO in these patients were mild and were not often seen in the clinical setting. This study suggested that early recognition of respiratory failure and referral for ECMO are vital to achieve a satisfactory outcome in AAV patients with DAH.
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Affiliation(s)
- Li Wang
- Department of Critical Care Medicine, The First Medical Center of PLA General Hospital, Haidian District, Beijing, China
| | - Jiang Wang
- Department of Pulmonary & Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Haidian District, Beijing, China
| | - Yi Xu
- Department of Pulmonary & Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Haidian District, Beijing, China
| | - Jie Jiao
- Department of Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Lixin Xie
- Department of Pulmonary & Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Haidian District, Beijing, China
| | - Guoxin Mo
- Department of Pulmonary & Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Haidian District, Beijing, China
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14
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Charya AV, Holden VK, Pickering EM. Management of life-threatening hemoptysis in the ICU. J Thorac Dis 2021; 13:5139-5158. [PMID: 34527355 PMCID: PMC8411133 DOI: 10.21037/jtd-19-3991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Life-threatening hemoptysis is commonly encountered in the ICU and its management can be challenging even for experienced clinicians. Depending on the etiology and severity, one can tailor the treatment modality and therapeutic intervention(s). The grading of severity of hemoptysis varies greatly in the literature; however, unlike hemorrhage in other scenarios, small amounts of blood can significantly impair oxygenation and ventilation leading to cardiovascular collapse. Importantly, the initial evaluation and management should focus on airway and hemodynamic stabilization along with maintenance of oxygenation and ventilation. In this review, we discuss commonly encountered etiologies, vascular anatomy, diagnostic evaluation, and therapeutic interventions. We examine the evolving trends in etiologies of life-threating hemoptysis over the years. The role of flexible and rigid bronchoscopy as both a diagnostic and therapeutic modality is explored, as well as the use and indications of several bronchoscopic techniques, such as topical hemostatic agents, endobronchial tamponade, and tranexamic acid (TXA). In addition, we assess the use of multi-row detector computed tomography as the initial rapid diagnostic method of choice and its use in planning for definitive treatment. The efficacy and long-term results of bronchial artery embolization (BAE) are evaluated, as well as indications for surgical intervention. Furthermore, the importance of a multidisciplinary approach is emphasized. The necessary interplay between intensivists, consultative services, and radiologists is described in detail and an algorithmic management strategy incorporating the above is outlined. Given the complexity in management of life-threatening hemoptysis, this paper aims to summarize the available diagnostic and therapeutic methods and provide a standardized approach for the management of patients with this often difficult to treat condition.
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Affiliation(s)
- Ananth V Charya
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Kim MJ, Shin K. Interstitial Lung Disease and Diffuse Alveolar Hemorrhage, the Two Key Pulmonary Manifestations in Microscopic Polyangiitis. Tuberc Respir Dis (Seoul) 2021; 84:255-262. [PMID: 34418915 PMCID: PMC8497773 DOI: 10.4046/trd.2021.0065] [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: 04/16/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
Microscopic polyangiitis (MPA) is an antineutrophil cytoplasmic antibody (ANCA)‒associated necrotizing vasculitis, which mainly affects small vessels in various organs, especially the lungs. The two key pulmonary manifestations, interstitial lung disease (ILD) and diffuse alveolar hemorrhage (DAH), increase the morbidity and death rate of patients with MPA. ILD is more common in MPA than in other ANCA-associated vasculitis subsets and is primarily associated with myeloperoxidase-ANCA. Unlike alveolar hemorrhage due to pulmonary capillaritis, ILD can initially manifest as isolated pulmonary fibrosis. Of note, its most frequent radiographic pattern is the usual interstitial pneumonia pattern, similar to the characteristic pattern seen in idiopathic pulmonary fibrosis. In this review we present the pathogenesis, clinical manifestations, and radiographic and histopathologic features of ILD and DAH in MPA. We also briefly summarize the outcome and therapeutic options for the two conditions.
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Affiliation(s)
- Min Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National Boramae Medical Center, Seoul, Republic of Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National Boramae Medical Center, Seoul, Republic of Korea
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16
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TAŞBAKAN MS. Diffüz alveoler hemoraji. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.863686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Elmokadem AH, Bayoumi D, Abo-Hedibah SA, El-Morsy A. Diagnostic performance of chest CT in differentiating COVID-19 from other causes of ground-glass opacities. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC7783705 DOI: 10.1186/s43055-020-00398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background To evaluate the diagnostic performance of chest CT in differentiating coronavirus disease 2019 (COVID-19) and non-COVID-19 causes of ground-glass opacities (GGO). Results A total of 80 patients (49 males and 31 females, 46.48 ± 16.09 years) confirmed with COVID-19 by RT-PCR and who underwent chest CT scan within 2 weeks of symptoms, and 100 patients (55 males and 45 females, 48.94 ± 18.97 years) presented with GGO on chest CT were enrolled in the study. Three radiologists reviewed all CT chest exams after removal of all identifying data from the images. They expressed the result as positive or negative for COVID-19 and recorded the other pulmonary CT features with mention of laterality, lobar affection, and distribution pattern. The clinical data and laboratory findings were recorded. Chest CT offered diagnostic accuracy ranging from 59 to 77.2% in differentiating COVID-19- from non-COVID-19-associated GGO with sensitivity from 76.25 to 90% and specificity from 45 to 67%. The specificity was lower when differentiating COVID-19 from non-COVID-19 viral pneumonias (30.5–61.1%) and higher (53.1–70.3%) after exclusion of viral pneumonia from the non-COVID-19 group. Patients with COVID-19 were more likely to have lesions in lower lobes (p = 0.005), peripheral distribution (p < 0.001), isolated ground-glass opacity (p = 0.043), subpleural bands (p = 0.048), reverse halo sign (p = 0.005), and vascular thickening (p = 0.013) but less likely to have pulmonary nodules (p < 0.001), traction bronchiectasis (p = 0.005), pleural effusion (p < 0.001), and lymphadenopathy (p < 0.001). Conclusions Chest CT offered reasonable sensitivity when differentiating COVID-19- from non-COVID-19-associated GGO with low specificity when differentiating COVID-19 from other viral pneumonias and moderate specificity when differentiating COVID-19 from other causes of GGO.
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18
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Asai A, Banno S, Asai N, Ito M, Sugiyama H, Yamaguchi M, Iwagaitsu S, Nobata H, Kinasi H, Katsuno T, Ito Y. Diffuse alveolar haemorrhage in a case with anti-RNA polymerase III antibody-positive systemic sclerosis successfully treated with plasma exchange and corticosteroid therapy. Mod Rheumatol Case Rep 2020; 4:51-55. [PMID: 33086969 DOI: 10.1080/24725625.2019.1680137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 63-year-old woman was admitted because of diffuse alveolar haemorrhage complicated with systemic sclerosis. High anti-RNA polymerase III (RNAP III) antibody titre was detected despite normal blood pressure and renal function. Antibodies other than anti-RNAP III antibody were negative. After initiation of methyl-prednisolone pulse therapy, the patient developed thrombotic microangiopathy (TMA) with exacerbation of respiratory failure, which required mechanical ventilation. However, renal function was preserved. We immediately started the patient on plasma exchange; subsequently, her diffuse alveolar haemorrhage and TMA dramatically improved. Diffuse alveolar haemorrhage with systemic sclerosis is generally occurred as pulmonary renal syndrome, and positive anti-RNAP III antibody is recognised as a predictive marker of scleroderma renal crisis. However, this case suggests that high anti-RNAP III antibody titre may play a role in the development of diffuse alveolar haemorrhage without scleroderma renal crisis.
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Affiliation(s)
- Akimasa Asai
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Shogo Banno
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Nao Asai
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Mayumi Ito
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Hirokazu Sugiyama
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Makoto Yamaguchi
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Shiho Iwagaitsu
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Hironobu Nobata
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Kinasi
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Katsuno
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
| | - Yasuhiko Ito
- Department of Rheumatology and Nephrology, Aichi Medical University, Nagakute, Japan
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19
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Sacoto G, Boukhlal S, Specks U, Flores-Suárez LF, Cornec D. Lung involvement in ANCA-associated vasculitis. Presse Med 2020; 49:104039. [PMID: 32650042 DOI: 10.1016/j.lpm.2020.104039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lung involvement is one of the most common clinical features in ANCA-associated vasculitides (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). In this review, we detail the five main presentations of pulmonary involvement in AAV: necrotizing granulomatous inflammation, tracheobronchial inflammation, pulmonary capillaritis, interstitial lung disease (ILD) and asthma with their clinical, radiological and therapeutic characteristics. The prevalence of these manifestations is variable according to the subtype of AAV, necrotizing granulomatous inflammation and tracheobronchial inflammation being defining features of GPA whereas ILD is primarily seen in patients with MPA, especially in association with ANCA directed against myeloperoxydase (MPO-ANCA), and asthma is characteristic of EGPA. Despite recent progresses in the diagnosis and management of these conditions, several questions remain and are discussed here, including local treatments for subglottic stenosis, the uncertain efficacy of plasma exchanges for alveolar hemorrhage, the potential role of antifibrotic agents in ILD associated with MPA, and the use of novel anti-IL-5 strategies in EGPA.
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Affiliation(s)
- Goethe Sacoto
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Col. Sección XVI, CP 14080, Mexico City, Mexico
| | - Sara Boukhlal
- Inserm UMR1227, lymphocytes B et autoimmunité, service de rhumatologie, université de Bretagne Occidentale, CHU de Brest, Brest, France
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Col. Sección XVI, CP 14080, Mexico City, Mexico
| | - Divi Cornec
- Inserm UMR1227, lymphocytes B et autoimmunité, service de rhumatologie, université de Bretagne Occidentale, CHU de Brest, Brest, France.
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20
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Goel MK, Chauhan M, Kumar A, Wadwa P, Maitra G, Talegaonkkar M, Dewan S. A Case of Refractory Hypoxemic Respiratory Failure due to Antineutrophil Cytoplasmic Antibodies-associated Diffuse Alveolar Hemorrhage Rescued by Extracorporeal Membrane Oxygenation. Indian J Crit Care Med 2020; 24:879-881. [PMID: 33132578 PMCID: PMC7584836 DOI: 10.5005/jp-journals-10071-23585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening disease. Mortality is very high in those patients who require mechanical ventilation. Traditionally, active bleeding has been considered a contraindication for extracorporeal membrane oxygenation (ECMO) support. There is limited evidence for ECMO in DAH as rescue therapy. Herein, we describe a case of antineutrophil cytoplasmic antibodies-associated DAH with intractable hypoxemic respiratory failure. An appropriate ventilator strategy failed to improve her hypoxemia leading to imminent risk to her life. The patient was rescued with veno-venous ECMO targeting lower than usual range of anticoagulation. ECMO proved to be lifesaving in our patient who was initiated on prompt immunosuppressive therapy and plasmapheresis along with continuous veno-venous hemodiafiltration and hemodynamic support. We feel that ECMO could be considered as adjunctive therapy in severe hypoxemic respiratory failure associated with DAH after careful consideration of the risk of bleeding and a restrictive anticoagulation strategy. How to cite this article: Goel MK, Chauhan M, Kumar A, Wadwa P, Maitra G, Talegaonkkar M, et al. A Case of Refractory Hypoxemic Respiratory Failure due to Antineutrophil Cytoplasmic Antibodies-associated Diffuse Alveolar Hemorrhage Rescued by Extracorporeal Membrane Oxygenation. Indian J Crit Care Med 2020;24(9):879–881.
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Affiliation(s)
- Manoj K Goel
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Munish Chauhan
- Department of Critical Care Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Ajay Kumar
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Pooja Wadwa
- Department of Critical Care Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Gargi Maitra
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Milind Talegaonkkar
- Department of Critical Care Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Sandeep Dewan
- Department of Critical Care Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
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21
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Seeliger B, Stahl K, Schenk H, Schmidt JJ, Wiesner O, Welte T, Kuehn C, Bauersachs J, Hoeper MM, David S. Extracorporeal Membrane Oxygenation for Severe ARDS Due to Immune Diffuse Alveolar Hemorrhage: A Retrospective Observational Study. Chest 2019; 157:744-747. [PMID: 31711988 DOI: 10.1016/j.chest.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/23/2019] [Accepted: 10/18/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany
| | - Heiko Schenk
- Department of Nephrology and Hypertension, Hannover, Germany
| | | | - Olaf Wiesner
- Department of Respiratory Medicine, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease, Hannover, Germany
| | - Sascha David
- Department of Nephrology and Hypertension, Hannover, Germany.
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22
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Surgery for Bacterial Endocarditis Complicated by Diffuse Alveolar Hemorrhage. Case Rep Cardiol 2019; 2019:3427381. [PMID: 31275663 PMCID: PMC6558607 DOI: 10.1155/2019/3427381] [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: 02/22/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
Diffuse alveolar hemorrhage is a very rare but potentially lethal condition resulting from various disorders. We report the case of a patient who suffered diffuse alveolar hemorrhage subsequent to bacterial endocarditis and survived aortic valve replacement, which was applied after improvement in respiratory distress. We believe that the strategy of respiratory functional recovery by aggressive rehabilitation is essential for the achievement of a successful surgical outcome in patients with alveolar hemorrhage.
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23
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Kraeva VV, Beketova TV. [Pulmonary hemorrhage in rheumatic diseases]. TERAPEVT ARKH 2019; 91:76-83. [PMID: 32598680 DOI: 10.26442/00403660.2019.05.000234] [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: 04/16/2020] [Indexed: 11/22/2022]
Abstract
In the article, we report the causes of pulmonary hemorrhage (PH) according to the literature data and own experience, with an emphasis on patients suffering from rheumatic diseases. Methods of diagnosis and modern approaches to the treatment of PH are analyzed.
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Affiliation(s)
- V V Kraeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
| | - T V Beketova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
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24
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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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25
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de Silva C, Mukherjee A, Jat KR, Lodha R, Kabra SK. Pulmonary Hemorrhage in Children: Etiology, Clinical Profile and Outcome. Indian J Pediatr 2019; 86:7-11. [PMID: 29948735 DOI: 10.1007/s12098-018-2725-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe etiology, clinical profile, treatment and outcome of children with pulmonary hemorrhage. METHODS A chart review of children with pulmonary hemorrhage attending Pediatric Pulmonology services of a tertiary care hospital in North-India was done. RESULTS Data of 44 children (mean age 59.2 ± 32.1 mo; 28 boys) were included for the study. Possible idiopathic pulmonary hemosiderosis 16 (36.4%), post infectious complications 11 (25%), immune mediated disorders 8 (18.2%), cardiac and vascular disorders 7 (15.9%), and airway pathologies 2 (4.5%) were the etiologies of pulmonary hemorrhage. Treatment options like medications, bronchial artery embolization and surgical resections were offered according to the etiology. Children with idiopathic pulmonary hemosiderosis and those with immune mediated diseases were treated with systemic steroids and steroid sparing agents; the latter group took longer time to respond and had more relapses. CONCLUSIONS Identification of main etiological categories of pulmonary hemorrhage in children could be useful to plan investigations and management of wide range of causes in more practical way.
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Affiliation(s)
- Channa de Silva
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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26
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Pataka A, Kotoulas SC, Sourla E, Panagiotidou E, Bagalas V, Fekete Passa K, Stanopoulos I. Is it just an infection? Breathe (Sheff) 2018; 14:e100-e104. [PMID: 30364482 PMCID: PMC6196322 DOI: 10.1183/20734735.021518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 75-year-old man (body mass index 24.49 kg·m−2) presents to the emergency department with fever, myalgia and dyspnoea, which he has had for the last 4 days. He quit smoking 15 years ago (40 pack-years). His only medical history is hypertension treated with valsartan and amlodipine. He travelled recently and stayed in a motel. On admission, his temperature is 38.7°C, blood pressure 132/67 mmHg, heart rate 102 beats per min and respiratory rate 24 breaths per min. Arterial blood gases (ABG) analysis shows severe hypoxaemia with arterial oxygen tension (PaO2) 47.1 mmHg (6.3 kPa), arterial carbon dioxide tension (PaCO2) 40.9 mmHg (5.5 kPa), pH 7.464, HCO3− 28.4 mmol·L−1 and arterial oxygen saturation (SaO2) 84.2% while breathing room air. Laboratory tests show anaemia (haemoglobin 10.7 g·dL−1), elevated white blood cells (11 420 per μL; 92.0% neutrophils and 4.6% lymphocytes), elevated C-reactive protein (19.97 mg·dL−1) and hyponatraemia with serum Na+ 127 mmol·L−1. The rest of laboratory tests are normal. Chest radiograph showa infiltrates in both lungs. Antibiotic therapy with intravenous ampicillin/sulbactam 3 g per 6 h and antiviral therapy with oral oseltamivir 75 mg per 12 h are initiated. Is it just an infection or something more?http://ow.ly/HEcH30lSO6a
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Affiliation(s)
- Athanasia Pataka
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Evdokia Sourla
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Vasilios Bagalas
- Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Ioannis Stanopoulos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
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27
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Parrot A, Voiriot G, Canellas A, Gibelin A, Nacacche JM, Cadranel J, Fartoukh M. Hémorragies intra-alvéolaires. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
L’hémorragie intra-alvéolaire (HIA), maladie rare, est une urgence thérapeutique, car elle peut conduire rapidement vers une insuffisance respiratoire aiguë asphyxiante avec décès. La triade, hémoptysie–anémie–infiltrat radiologique, suggère le diagnostic d’HIA, mais elle peut manquer dans deux tiers des cas, y compris chez des patients en détresse respiratoire. La tomodensitométrie thoracique peut aider dans les formes atypiques. Le diagnostic d’HIA repose sur la réalisation d’un lavage bronchoalvéolaire. Les étiologies en sont très nombreuses. Il importera de séparer, en urgence, les HIA d’origine non immune, avec un dépistage de celles d’origine septique qui doivent bénéficier d’une enquête microbiologique ciblée et cardiovasculaire avec la réalisation d’une échographie cardiaque, des HIA immunes (les vascularites liées aux anticorps anticytoplasme des polynucléaires neutrophiles, les connectivites et le syndrome de Goodpasture), avec la recherche d’autoanticorps et la réalisation de biopsies au niveau des organes facilement accessibles. La biopsie pulmonaire doit rester exceptionnelle. En cas d’HIA immune inaugurale, un traitement par stéroïdes et cyclophosphamide peut être débuté. Les indications du rituximab commencent à être mieux établies. Le bénéfice des échanges plasmatiques est débattu. En cas de réapparition d’infiltrats pulmonaires, chez un patient suivi pour une HIA immune, on s’efforcera d’écarter une infection dans un premier temps.
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