title: Diffuse Alveolar haemorrhage: a fatal complication after alemtuzumab induction therapy in renal transplantation.
abstract: We report a fatal case of alemtuzumab-induced diffuse alveolar hemorrhage in an 18-year-old male with Alport syndrome. The patient developed acute onset shortness of breath, hemoptysis and fever after renal transplantation. Computed tomography findings were consistent with adult respiratory distress syndrome. Bronchoscopy and broncho-alveolar lavage was performed that showed no evidence of pathogenic bacteria or opportunistic infection. The patient was intubated and ventilated because of worsening respiratory function. The patient received plasma electrophoresis and was maintained on tacrolimus and steroids; however, unfortunately the patient died 31 days post-transplantation due to worsening respiratory function and declining graft function. Although the prevalence and the exact mechanism of this fatal complication remain unknown, an awareness of this complication is important to all clinicians using alemtuzumab. This is a second report of diffuse alveolar hemorrhage secondary to alemtuzumab induction in patients with Alport syndrome.
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, United Kingdom.
authors: W
authors: W
authors: Tahir
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, United Kingdom.
authors: A
authors: A
authors: Hakeem
authors: Department of Renal Medicine, St James's University Hospital, Leeds, United Kingdom.
authors: R
authors: R
authors: Baker
authors: Division of Surgery, Department of Transplantation, St James's University Hospital, Leeds, United Kingdom. Electronic address: niaz.ahmad@leedsth.nhs.uk.
authors: N
authors: N
authors: Ahmad
mesh_terms: D000293:Adolescent; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D017809:Fatal Outcome; D006469:Hemoptysis / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D060828:Induction Chemotherapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008171:Lung Diseases / Q000139:chemically induced*; D008297:Male; D009394:Nephritis, Hereditary / Q000601:surgery; D011650:Pulmonary Alveoli; D012128:Respiratory Distress Syndrome / Q000139:chemically induced; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab; D016559:Tacrolimus