Diffuse Alveolar Hemorrhage in Critically Ill Cancer Patients

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

“…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 ]. It is imperative that the intensivist rules out infectious etiologies and fluid overload states when considering DAH as a diagnosis [ 2 , 3 ]. In our case, we initially considered TRALI as one of the major differential diagnoses given the temporal proximity of the patient’s blood transfusion; however, despite halting blood product transfusions, continuing mechanical ventilation, and ruling out all other sources of bleeding, his hemoglobin levels continued to decrease.…”

“…Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary condition characterized by hypoxemia with progression to respiratory failure, rapid onset of dyspnea, and blood loss anemia [ 1 ]. While hemoptysis may be present and corroborates the diagnosis, it is absent in about half of the cases, resulting in a diagnostic challenge with variable presenting symptoms [ 2 , 3 ]. Imaging findings on chest x-ray or computed tomography (CT) scans are also non-specific, often showing diffuse bilateral alveolar opacities.…”

“…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 ].…”

“…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 ].…”