Fatal re-expansion pulmonary edema associated with increased lung IL-8 levels following high-dose chemotherapy and autologous stem cell transplant.
Re-expansion pulmonary edema (REPE) leading to hypoxic respiratory failure and death occurred following a unilateral low-volume (750 ml) thoracentesis in a young patient 8 days after high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) for advanced-stage breast cancer. A higher volume (1,000 ml) thoracentesis from the contralateral lung, 2 weeks prior to HDC/ASCT, showed no clinical consequences. We have recently demonstrated increased levels of inflammatory cytokines in the lungs of patients following HDC/ASCT, a finding which may predispose them to exaggerated inflammatory lung injury. In postmortem analysis, this patient's lung demonstrated substantial intra-alveolar edema and marked elevation in interleukin-8, detected by immunohistochemistry. This suggests that patients who have recently undergone HDC/ASCT may be at increased risk for the development of REPE following thoracentesis.
Garantziotis
Stavros
S
Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Bhalla
Karan S
KS
Long
Gwynn D
GD
Vredenburgh
James J
JJ
Folz
Rodney J
RJ
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007150:Immunohistochemistry; D016209:Interleukin-8 / Q000032:analysis*; D008168:Lung / Q000737:chemistry* / Q000473:pathology; D011654:Pulmonary Edema / Q000473:pathology / Q000503:physiopathology*
D016209:Interleukin-8