Cytarabine-induced lung injury: case report

Abstract

We report the case of a 65-year-old male patient with acute myelogenous leukemia who developed severe respiratory failure after receiving cytarabine treatment. Chest radiograph showed bilateral alveolar infiltrates. He was intubated and underwent flexible bronchoscopy. An extensive diagnostic work-up revealed no evidence of infection. Steroids were added to empiric antibiotic treatment and the patient was successfully extubated in 5 days. Cytarabine-induced lung injury should be considered in the differential diagnosis of alveolar infiltrates in immunocompromised patients. If bronchoscopy fails to confirm an infectious cause, a short course of steroids must be tried, which probably leads to a favorable outcome.

Diffuse Alveolar Hemorrhage in the Setting of Cytarabine Therapy in a Critically Ill Patient

“…Although this limitation exists, it is our contention that our patient’s DAH was most likely a result of cytarabine therapy, as multiple urinalyses failed to demonstrate hematuria, which represents renal involvement, characteristic of vasculitides. Additionally, the patient’s clinical course and diagnostic work-up support the observations of Maini et al, Kanaya & Kondo, and Kopterides et al, which demonstrated that a diagnosis of cytarabine-induced DAH is possible after ruling out all other possible etiologies of pulmonary hemorrhage [ 1 , 4 , 6 ]. Thus, when a patient presents with diffuse bilateral, ground-glass opacities on chest radiograph, intensivists should consider DAH as a differential diagnosis due to the severe disease burden and many underlying causes of DAH.…”

“…DAH is a life-threatening condition that is most commonly a result of systemic vasculitides; however, it is less commonly associated with cytotoxic drugs and malignancy [ 1 , 2 ]. A diagnosis of DAH in the setting of cytarabine treatment is extremely rare, with only several case reports noted in the current literature [ 1 , 3 , 4 , 6 ]. Differential diagnoses for DAH include infectious and non-infectious causes of pulmonary edema such as TRALI, exacerbation of congestive heart failure, bronchiolitis obliterans, acute eosinophilic pneumonia, aspiration pneumonitis, neurogenic pulmonary edema, opioid overdose, and pulmonary infection [ 1 ].…”

“…The general management of DAH includes supportive care with oxygen supplementation or mechanical ventilation, avoiding anticoagulation, and reversing coagulopathy [ 2 ]. A short course of systemic steroids is also recommended in addition to rituximab, cyclophosphamide, or plasma exchange depending on the etiology [ 6 ]. In patients with suspected drug-induced DAH, it is also important to withhold the offending agent [ 2 ].…”

Sudden hemoptysis originating from spontaneous right bronchial artery bleeding during arterial duct closure in an adult patient with chronic myeloid leukemia

“…Previous reports have documented cases of diffuse alveolar hemorrhage and pulmonary edema in patients with leukemia treated with cytarabine; such complications are closely associated with damage to the capillary endothelium and alveolar epithelium caused by chemotherapy drugs. Some patients have even developed symptoms such as hemoptysis [7,8]. Similarly, studies have demonstrated that TKIs can disrupt endothelial cell growth and survival, leading to an anti-angiogenic phenotype and potential impairment of the structural and functional integrity of blood vessels [9].…”

Respiratory Tract Diseases That May Be Mistaken for Infection

“…Cytarabine, commonly used to treat acute myeloid leukemia (AML), may cause non-cardiogenic pulmonary edema. This is usually responsive to steroid therapy and is resolved prior to transplant [39]. Dasatinib is a tyrosine kinase inhibitor useful in the treatment of CML.…”