Diffuse pulmonary alveolar hemorrhage

Schmidt-Wolf I, Schwerdtfeger R, Schwella N, Gallardo J, Schmid HJ, Huhn D, Siegert W (1993) Diffuse pulmonary alveolar hemorrhage after allogeneic bone marrowtrans-plantation. Ann Hematol 67 139-141... 

Nicolls MR, Terada LS, Tuder RM, Prindiville SA, Schwarz MI. Diffuse alveolar hemorrhage with underlying pulmonary capillaritis in the retinoic acid syndrome. Am J Respir Crit Care Med 1998 158(4) 1302-5. 

Acute renal insufficiency together with diffuse alveolar hemorrhage and bilateral pulmonary infiltrates was suspected to have been caused by penicillamme (500 mg/day for 6 months) in a 34-year-old white woman, who took penicillamine for progressive systemic sclerosis (234). Because of disseminated intravascular coagulation, a biopsy was not made and the role of penicillamine remained uncertain. 

Early-onset amiodarone toxicity due to diffuse alveolar hemorrhage, with respiratory distress, hemoptysis, severe hj oxia, and bilateral pulmonary infiltrates has been described in a 46-year-old man taking amiodarone [32" ]. 

Respiratoiy A 53-year-old man with chronic pulmonary aspergillosis developed near-fatal diffuse alveolar hemorrhage after receiving intravenous itraconazole a lymphocyte stimulation test was positive he did not respond to methylprednisolone but responded dramatically to hemoperfusion using a poly-m) in B-immobiUzed fiber column P6 ]. 

Schwarz MI, Sutarik JM, Nick JA, et al. Pulmonary capillaritis and diffuse alveolar hemorrhage. A primary manifestation of polymyositis. Am J Respir Crit Care Med 1995 151 2037-2040. 

The posttransplant period is divided into three phases preengraftment (0 to 30 days), early postengraftment (30-100 days) and late posttransplant (>100 days). The pulmonary complications follow characteristic time patterns (2). Although infections may present as diffuse pulmonary or bronchiolar disorders, this chapter will focus on noninfectious complications. Among the noninfectious pulmonary complications, pulmonary edema, diffuse alveolar hemorrhage (DAH) and periengraftment respiratory distress syndrome (PERDS) usually occur during... 

Acute pulmonary edema Diffuse alveolar hemorrhage Periengraftment respiratory distress syndrome Bronchiolitis obliterans syndrome Bronchiolitis obliterans organizing pneumonia Idiopathic pulmonary syndrome Delayed pulmonary toxicity syndrome Pulmonary cytolytic thrombi Pulmonary veno-occlusive disease Progressive pulmonary fibrosis Pulmonary hypertension Hepatopuhnonary S3mdrome Pulmonary alveolar proteinosis Eosinophilic pneumonia... 

Figure 1 Timing of the major noninfectious pulmonary complications following blood and marrow transplantation. Abbreviations. BO, bronchiolitis obUterans DAH, diffuse alveolar hemorrhage GVHD, graft versus host disease IPS, idiopathic pneumonia syndrome P edema, pulmonary edema PERDS, periengraftment respiratory distress syndrome phase I, preengraftment period phase II, early postengraftment period phase III, late postengraftment period.

Figure 5 A portable chest radiograph of a bone marrow transplant recipient with DAH showing bilateral diffuse pulmonary infiltrates. Abbreviation. DAH, diffuse alveolar hemorrhage.

Histologically, these lesions correspond to UIP or NSIP. The administration of high doses of steroids may prevent the progression to fibrosis, although the evidence remains scarce. Combination therapy with vinca alkaloids has been associated with a more acute presentation, which histologically corresponds to DAD. The response to steroids is incomplete but may prevent progression to fibrosis. Diffuse alveolar hemorrhage and pulmonary veno-occlusive disease have also been reported (1). 

Transretinoic acid has dramatically changed the management of acute promye-locytic leukemia. It allows the maturation of leukemic cells and induces remission. It is typically used in association with daunombicin and cytosine arabinoside. The retinoic acid syndrome occurs in 25% of patients and consists of a capillary leak syndrome with noncardiogenic pulmonary edema (14). Diffuse alveolar hemorrhage is also a well-documented complication. 

Gefitinib is a tyrosine kinase inhibitor used in the treatment of refractory non-small cell carcinoma of the lung. Respiratory failure has been observed in 1 % of the cases with a 30% fatality rate and corresponds histologically to DAD with possible progression to fibrosis (4). Diffuse alveolar hemorrhage has also been reported. Rare cases of pulmonary complications with imatinib mesylate (used in chronic myelogenous leukemia) have also been described. 

Pulmonary hemorrhage occurs infrequently in patients with SLE. While blood-streaked sputum may occur with almost any lung process, diffuse alveolar... 

Figure 4 (A) Chest radiograph of a patient with MPO-ANCA vasculitis who presented with pulmonary hemorrhage and renal failure, demonstrating diffuse alveolar shadowing. Additionally, a central venous dialysis catheter is visible in the right internal jugular vein. (B) CT scan of a patient with pulmonary fihrosis diagnosed concurrently with their renal failure due to MPO-ANCA-associated vasculitis, demonstrating the characteristic hon-eycomhing pattern.

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