Diffuse alveolar hemorrhage following itraconazole injection.
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.
Izumikawa
Koichi
K
The Second Department of Internal Medicine, Nagasaki University School of Medicine. koizumik@nagasaki-u.ac.jp
Nakano
Ken
K
Kurihara
Shintaro
S
Imamura
Yoshifumi
Y
Yamamoto
Kazuko
K
Miyazaki
Taiga
T
Sakamoto
Noriho
N
Seki
Masafumi
M
Ishimatsu
Yuji
Y
Kakeya
Hiroshi
H
Yamamoto
Yoshihiro
Y
Yanagihara
Katsunori
K
Tsuchiya
Tomoshi
T
Yamasaki
Naoya
N
Tagawa
Tsutomu
T
Mukae
Hiroshi
H
Nagayasu
Takeshi
T
Kohno
Shigeru
S
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
D000935:Antifungal Agents; D017964:Itraconazole; D011112:Polymyxin B