Adult respiratory distress syndrome in patients with malignant astrocytoma--three case reports.
Three patients treated for intracranial malignant astrocytomas developed adult respiratory distress syndrome (ARDS). All three patients had a Karnofaky performance status score of at least 80% and similar clinical characteristics. All demonstrated hypersensitivity to phenytoin. ARDS occurred in two patients during radiotherapy and in one with radiation-induced brain damage following initial radiochemotherapy. ARDS occurred shortly after tapering the long-term administration of betamethasone. The initial symptoms were dry cough, fever, and generalized toxic eruption. Serum lactic acid dehydrogenase (LDH) concentrations were increased up to 2500 IU/l. Several days later, the patients suddenly complained of dyspnea. All patients fulfilled the diagnostic criteria for ARDS. Two patients recovered, but a young woman died. Clinical symptoms such as fever of unknown origin, dry cough and skin eruptions, accompanied by abnormally increased serum LDH concentrations during or following the tapering of long-term administration of corticosteroids, are warning signs of ARDS in patients being treated for malignant gliomas.
Kumabe
T
T
Department of Neurosurgery, Tohoku University School of Medicine, Sendai.
Tominaga
T
T
Yoshimoto
T
T
Kayama
T
T
D000328:Adult; D001254:Astrocytoma / Q000150:complications* / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017567:Karnofsky Performance Status; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013902:Radiography, Thoracic; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications* / Q000175:diagnosis