Introduction: Pulmonary alveolar microlithiasis (PAM) is an autosomal recessive disease characterized by the deposition of phosphate and calcium in the alveoli. The disease progresses asymptomatically until later stages. When it becomes symptomatic, lung transplantations performed before the onset of right heart failure may improve life expectancy and quality. Here we present a case report concerning the very first Turkish PAM patient to have undergone lung transplantation surgery. Patient information: A 52 year-old female, Caucasian patient, already diagnosed with PAM in infancy, was admitted to the intensive care unit, diagnosed with pneumonia and hospitalized for 20 days. We decided to refer the patient to a specialized center for lung transplantation. Bilateral lung transplantation was performed in Vienna 14 months later and no recurrence was observed during the first postoperative year. Conclusion: Bilateral lung transplantation may improve both the life expectancy and the quality of life of PAM diagnosed patients with severe respiratory failure who do not suffer from right heart failure. The risk of recurrence should not be considered as a justifying reason to avoid transplantation as a treatment method.

SUMMARY Red cell exchange transfusion (RCET) is a treatment option for severe falciparum malaria, which reduces the parasite load and toxemia. Pulmonary edema, metabolic changes, hyperkalemia, arrhythmia, hypocalcemia due to citrate toxicity, rebound hypoglycemia, hypothermia, anaphylactic reactions, hypotension or hypertension, thrombocytopenia, thrombo-embolism, coagulopathy, and necrotizing enterocolitis are the major acute phase RCET complications. In our case of severe falciparum malaria that was resistant to treatment; reduction in parasite load and sepsis was observed following RCET, but severe acute respiratory distress syndrome (ARDS) has developed. Key Words: Severe falciparum malaria, red cell exchange transfusion, acute respiratory distress sendrome (ARDS) ÖZET Eritrosit süspansiyonu ile kan değişimi (red cell exchange transfüzyon, RCET) ciddi falciparum sıtmasında parazit yükü ve toksemiyi azaltmak için uygulanan bir tedavi seçeneğidir. Pulmoner ödem, metabolik değişiklikler, hiperkalemi, aritmi, sitrat toksisitesine bağlı hipokalsemi, rebound hipoglisemi, hipotermi, anafl aktik reaksiyonlar, hipotansiyon veya hipertansiyon, trombositopeni, tromboembolizm, koagülopati ve nekrotizan enterokolit RCET uygulamasının erken döneminde görülebilen majör komplikasyonlardır. Tedaviye direnç gelişmiş ciddi falciparum tanılı olgumuzda, RCET sonrası parazit yükü ve septik tabloda gerileme olmasına rağmen ciddi akut respiratuar distres sendromu (ARDS) gelişmiştir.Anah tar Ke li me ler: Ciddi falciparum sıtması, eritrosit süspansiyonu ile kan değişimi, akut respirator distres sendromu (ARDS)

12leomycin sulphate is a mixture of cytotoxic glycopeptide antibiotics isolated from a strain of Streptomyces verticillus.1 Use of bleomycin in squamous cell carcinoma, lymphoma, testicular carcinoma and malignant pleural effusion has been associated with the development of pulmonary fibrosis in 1% of cases.2 Development of alveolitis in the early period of bleomycin-induced inflammation and fibrosis due to chronic inflammation have been demonstrated. 3,4 In the acute phase, an increase in the prothrombotic and procoagulant activity while a decrease in the fibrinolytic activity occurs in the bronchoalveolar compartment.5 Fibroblast deposition in the lung capillary endothelial cells, possibly through endothelial-mesenchymal transition was also shown in bleomycin-induced pulmonary fibrosis. 6 Herein we report development of pulmonary fibrosis following bleomycin treatment in Bleomycin-Induced Pulmonary Fibrosis, Severe Hypoxia and Intracardiac Air Embolism:Case Report A AB BS ST TR RA AC CT T Bleomycin sulphate is a mixture of cytotoxic glycopeptide antibiotics isolated from a strain of Streptomyces verticillus. Use of bleomycin in squamous cell carcinoma, lymphoma, testicular carcinoma and malignant pleural effusion has been associated with the development of pulmonary fibrosis in 1% of cases. Bleomycin-induced pulmonary fibrosis results in severe hypoxemia due to inflammation that develops in the alveolar capillary membrane and this patients are associated with less-than-expected response to medical treatment besides the likelihood of complications related to mechanical ventilation. Herein, we report development of severe hypoxemia and intracardiac air embolism under mechanical ventilation who has no response to medical treatment in a 39-year-old male patient following bleomycin treatment.K Ke ey y W Wo or rd ds s: : Bleomycin; pulmonary fibrosis; embolism, air Ö ÖZ ZE ET T Bleomisin sülfat, Streptomyces verticillus'un bir alt türünden izole edilmiş sitotoksik glikopeptid antibiyotiklerin bir karışımıdır. Skuamöz hücreli karsinom, lenfoma, testiküler karsinom ve malign plevral effüzyonda kullanılan bleomisine bağlı %1 olguda pulmoner fibrozis gelişmektedir.Bleomisin'e bağlı gelişen pulmoner fibrozis alveolokapiller membranda inflamasyon oluşumuna bağlı ciddi hipoksi ile sonuçlanır. Bu hastalarda medikal tedaviye yanıt beklenenden azdır ayrıca mekanik ventilasyona bağlı olası komplikasyonlar gelişmektedir. Bleomisin tedavisini takiben pulmoner fibrozis gelişen, medikal tedavilere yanıt alınamayan, ciddi hipoksi ile seyreden ve mekanik ventilasyon altında intrakardiyak hava embolisi gelişen 39 yaşındaki erkek olgumuz sunulmuştur.A An na ah ht ta ar r K Ke el li im me el le er r: : Bileomisin; pulmoner fibrozis; emboli, hava T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J C Ca as se e R Re ep p 2 20 01 15 5; ;2 23 3( (1 1) ): :1 12 2--5 5

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