title: Pulmonary capillary bleeding in a patient with severe left ventricular failure after acute myocardial infarction under anti-thrombotic therapy.
abstract: 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.
authors.affiliation: The First Department of Internal Medicine, Fukushima Medical University. kishikaw@fmu.ac.jp
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Oikawa
authors.forename: Taeko
authors.initials: T
authors.lastname: Ishii
authors.forename: Motoko
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamaguchi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Mitsugi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munakata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Maruyama
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents