title: A case of diffuse alveolar hemorrhage associated with tegafur plus uracil and warfarin therapy.
abstract: A 72-year-old man who received warfarin for myocardial infarction (prothrombin time-international normalized ratio [PT-INR] controlled between 2.2 and 2.5) for 2 years. He developed lung cancer, underwent surgery, and received tegafur plus uracil (UFT) after 1 month. After 2 months, he was admitted for hemoptysis and dyspnea. Chest radiography and computed tomography showed bilateral alveolar infiltration (PT-INR, 8.9). Bronchoalveolar lavage fluid (BALF) disclosed hemorrhagic features in sequential samples. And he was diagnosed with diffuse alveolar hemorrhage (DAH). A known interaction exists between fluoropyrimidines and warfarin. So, they were discontinued, and vitamin K was intravenously administered. One day later, the PT-INR returned to 1.14. The symptoms improved and, alveolar infiltration resolved after 2 weeks. Alveolar hemorrhage may be due to an interaction between UFT and warfarin. When fluoropyrimidines and warfarin are prescribed simultaneously, we recommend that PT-INR should be closely monitored.
authors.affiliation: Department of Respiratory Medicine, Tokyo Medical University, 3-20-1, Chuou, Ami, Inashiki, Ibaraki 300-0395, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Itoh
authors.forename: Shuji
authors.initials: S
authors.lastname: Oh-Ishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto
authors.forename: Seitaro
authors.initials: S
authors.lastname: Senba
authors.forename: Hideki
authors.initials: H
authors.lastname: Adachi
authors.forename: Koji
authors.initials: K
authors.lastname: Kishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Harumi
authors.initials: H
authors.lastname: Takahashi