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Diffuse alveolar hemorrhage following alemtuzumab
Ashutosh Sachdeva1, George M Matuschak1
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO.
Chest
|June 25, 2008
Summary
A rare case of diffuse alveolar hemorrhage (DAH) occurred in a kidney transplant patient with X-linked Alport syndrome (XLAS) treated with alemtuzumab. This serious pulmonary complication resolved with steroid treatment.
Area of Science:
- Nephrology
- Pulmonology
- Transplantation Immunology
Background:
- X-linked Alport syndrome (XLAS) is a genetic kidney disease often requiring renal transplantation.
- Alemtuzumab is an immunosuppressive agent used in transplantation protocols.
- Pulmonary complications of immunosuppression can be severe and varied.
Observation:
- A 26-year-old man with XLAS developed dyspnea and hemoptysis post-renal transplant.
- Alemtuzumab was administered as part of the immunosuppressive induction therapy.
- Chest CT revealed diffuse alveolar opacities, and bronchoscopy showed hemorrhagic BAL fluid.
Findings:
- The patient presented with diffuse alveolar hemorrhage (DAH), a rare complication.
- No infectious etiology was identified, suggesting a drug-induced toxicity.
- Symptoms improved with corticosteroid therapy, and the patient required mechanical ventilation for respiratory failure.
Implications:
- This is the first reported case of DAH associated with alemtuzumab therapy in a transplant recipient.
- Alemtuzumab may pose a risk for DAH, particularly in patients with underlying conditions like XLAS.
- Further studies are needed to determine the prevalence and mechanisms of this pulmonary toxicity.
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