Pulmonary capillary bleeding in a patient with severe left ventricular failure after acute myocardial infarction under anti-thrombotic therapy.
A 52-year-old man who was admitted for cardiogenic shock after acute myocardial infarction developed severe left ventricular dysfunction despite reperfusion therapy with coronary stents. After the 40th hospital day, he started to have cough and pulmonary infiltrates. Antimicrobial therapies and subsequent prednisolone for bronchiolitis obliterans organizing pneumonia were ineffective. Bronchoscopic examination revealed diffuse pulmonary bleeding and exudation of hemosiderin-containing macrophages in bronchial lavage fluid. Pulmonary capillary bleeding has been reported in the terminal stage of patients with mitral stenosis in the pre-cardiac surgery era. This complication reemerges in patients with severe heart failure receiving intensive anti-coagulation therapy after implanting a sirolimus-eluting coronary stent.
Ishikawa
Kazunobu
K
The First Department of Internal Medicine, Fukushima Medical University. kishikaw@fmu.ac.jp
Kaneko
Hironori
H
Oikawa
Masayoshi
M
Ishii
Taeko
T
Yoshikawa
Motoko
M
Yamaguchi
Osamu
O
Ishikawa
Shunichi
S
Mitsugi
Minoru
M
Munakata
Mitsuru
M
Maruyama
Yukio
Y
D000208:Acute Disease; D000792:Angiography; D002196:Capillaries / Q000503:physiopathology; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000503:physiopathology; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000209:etiology
D005343:Fibrinolytic Agents