title: Acute respiratory distress syndrome as an initial presentation of hemophagocytic lymphohistiocytosis after induction therapy for acute myeloid leukemia.
abstract: A 7-month-old girl with acute myeloid leukemia (AML) developed acute respiratory distress syndrome (ARDS) during the pancytopenic period after induction chemotherapy. Respiratory failure did not improve despite intensive treatments. Eventually, hemophagocytic lymphohistiocytosis (HLH) was diagnosed based on hemophagocytosis in bone marrow, and high soluble interleukin-2 receptor (sIL-2R) and ferritin levels. Even after cyclosporin A was started against HLH, she did not recover. Autopsy showed macrophage proliferation in bone marrow and lymph nodes. HLH should be considered, even in the pancytopenic period after chemotherapy, when patients develop ARDS that does not respond to supportive therapies.
authors.affiliation: Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. adu44150@ams.odn.ne.jp
authors.forename: Takuro
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tanabe
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shinkoda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kodama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kakihana
authors.forename: Masamichi
authors.initials: M
authors.lastname: Goto
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D016572:Cyclosporine / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D015375:Receptors, Interleukin-2 / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000970:Antineoplastic Agents; D015375:Receptors, Interleukin-2; D016572:Cyclosporine; D005293:Ferritins