title: Diffuse alveolar hemorrhage following itraconazole injection.
abstract: Diffuse alveolar hemorrhage (DAH) syndrome is potentially fatal. We encountered a nearly fatal case of DAH possibly due to intravenous itraconazole (ITCZ). A 53-year-old man with chronic pulmonary aspergillosis underwent pneumonectomy of the left lung 15 days prior to the onset of DAH, which was confirmed by bronchoalveloar lavage. The battery of diagnostic evaluations performed revealed no other positive etiological factor, leading to the diagnosis of DAH possibly induced by intravenous ITCZ with a positive drug lymphocyte stimulation test. The patient did not respond to pulse methylprednisolone therapy, but responded dramatically to direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX) therapy.
authors.affiliation: The Second Department of Internal Medicine, Nagasaki University School of Medicine. koizumik@nagasaki-u.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Nakano
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kurihara
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Imamura
authors.forename: Kazuko
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Noriho
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Seki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ishimatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakeya
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamasaki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tagawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mukae
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002908:Chronic Disease; D006464:Hemoperfusion; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D007275:Injections, Intravenous; D017964:Itraconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008171:Lung Diseases / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B; D055732:Pulmonary Aspergillosis / Q000188:drug therapy
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D011112:Polymyxin B