Pulmonary benign metastasizing leiomyoma presented as acute hypoxemic respiratory failure: A case report

Abstract

Pulmonary benign metastasizing leiomyoma is a rare disease, and it often occurs in women of childbearing age with a history of uterine smooth muscle tumors and uterine leiomyoma surgery. The disease progression in PBML is often unpredictable and depends on the condition of the extent to which the lung is involved. Generally, most patients are asymptomatic, but a few have cough, wheezing, or shortness of breath, which are often misdiagnosed as pneumonia. Therefore, it has a large difficulty of treatment and nursing in pre-diagnosis. This paper reports a 35-year-old woman who was primarily diagnosed with acute hypoxic respiratory failure and transferred to the intensive care unit from the emergency room. The patient's lung Initial computed tomography scan shows that it is diffuse interstitial pneumonia, but no bacteria, fungi, or viruses were detected by sequencing of the alveolar lavage pathogenic macroscopic genome. Besides, the patient had a persistent hypoxic state before the definitive diagnosis. So, we focused on maintaining the airway patency of the patient, using prone ventilation, inhaling nitric oxide, monitoring electrical impedance tomography, and preventing ventilator-associated pneumonia to improve oxygenation, to wait for the immunohistochemical staining of the patient's biopsied lung tissue, which could help us to clarify a diagnosis and treat it base on etiology. After careful treatment and nursing, the patient was removed from the ventilator after 26 days and was transferred to the respiratory ward after 40 days. This meeting could provide a reference for clinical practice and help the patient who is suffering from PBML.