title: Sequential adjuvant chemoradiotherapy-induced diffuse alveolar haemorrhage in a patient with breast cancer successfully treated with corticosteroid plus recombinant human soluble thrombomodulin.
abstract: The effective treatment for corticosteroid (CS)-refractory sequential chemoradiotherapy (CRT)-induced lung injury has not been established. We report a case of sequential CRT-induced diffuse alveolar haemorrhage (DAH) successfully treated with CS therapy plus recombinant human soluble thrombomodulin (rhTM). A 69-year-old woman was treated with sequential adjuvant CRT for early-stage breast cancer. After sequential CRT, she suffered from progressive dyspnoea. Chest CT scan showed consolidations in the irradiation field and diffuse ground-glass attenuations in the non-irradiation regions. We suspected sequential CRT-induced DAH because of increased haemosiderin-laden macrophages in bronchoalveolar lavage fluid. Her clinical conditions did not improve with high-dose CS therapy. Therefore, rhTM was added, and her disease and serum high-mobility group box-1 levels improved rapidly. Therefore, rhTM plus CS might be a safe and effective treatment for sequential CRT-induced lung injury, although further study is necessary to validate these findings.
authors: Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan.
authors: Takamasa
authors: T
authors: Kitajima
authors: Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan.
authors: Satoshi
authors: S
authors: Marumo
authors: Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Breast Center, Osaka, Japan.
authors: Yurina
authors: Y
authors: Maeshima
authors: Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Respiratory Disease Center, Osaka, Japan.
authors: Motonari
authors: M
authors: Fukui
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000209:etiology; D008775:Methylprednisolone / Q000627:therapeutic use*; D011650:Pulmonary Alveoli; D011994:Recombinant Proteins / Q000627:therapeutic use; D018180:Thrombomodulin / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D011994:Recombinant Proteins; D018180:Thrombomodulin; D008775:Methylprednisolone