Acute lung injury during antithymocyte globulin therapy for aplastic anemia.
The case of a 33-year-old man with aplastic anemia who experienced recurrent episodes of hypoxemia and pulmonary infiltrates during infusions of antithymocyte globulin (ATG) is described. With the use of high-dose corticosteroids, the patient's original episodes resolved, and were subsequently prevented before additional administrations of ATG. Rare reports of an association between ATG and acute lung injury are found in the literature, but this is the first report of successful steroid-supported re-exposure. Although the mechanism of ATG-related acute lung injury remains uncertain, it may be parallel to the mechanism of transfusion-related acute lung injury because the pathogenesis of the latter relies, in part, on antileukocyte antibodies. ATG-related toxicity should be included in the differential diagnosis of new, infusion-associated pulmonary infiltrates, and corticosteroids may be a useful therapeutic consideration in the management.
Goligher
Ewan Christopher
EC
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Cserti-Gazdewich
Christine
C
Balter
Meyer
M
Gupta
Vikas
V
Brandwein
Joseph E
JE
D055371:Acute Lung Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000741:Anemia, Aplastic / Q000188:drug therapy*; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum