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Non-infectious diffuse alveolar haemorrhage: case report A 52-year-old man developed non-infectious diffuse alveolar haemorrhage during treatment with cytarabine and idarubicin for acute myeloid leukaemia (AML). The man, who had a history of bone marrow aspiration, was diagnosed with AML with inv(16)(p13.1q22);CBFB-MYH11 and AML M4Eo. Therefore, he started receiving induction chemotherapy with idarubicin and cytarabine (3 + 7 days) [routes and doses not stated]. However, on the very second day of the induction therapy, he developed a little bloody sputum. On the day 3, he developed a low-grade fever over 37.5 °C and fell into acute respiratory failure because of haemoptysis. He was then given oxygen support with nasal cannula to maintain arterial oxygen saturation above 95%. Chest radiograph showed bilateral pulmonary consolidation and air bronchogram. Thoracic CT showed interlobular septal thickening and diffuse ground-glass opacities. Based on these findings a diagnosis was confirmed with diffuse alveolar haemorrhage (DAH). His WBC’s were found to be 7900 /µL with 31% blasts, platelet count was 35,000 /µL and haemoglobin concentration was 7.5 g/dL. Whereas, his blood biochemistry and the coagulation profile did not suggest disseminated intravascular coagulation or tumour lysis syndrome. Moreover, sputum and blood culture showed negative results for various bacterial and viral infections. Hence, the diagnosis was confirmed with non-infectious DAH. The man stopped receiving induction chemotherapy and methylprednisolone pulse therapy was started. He also received levofloxacin and ceftazidime for febrile neutropenia. On the very next day after starting methylprednisolone pulse therapy, respiratory failure and bloody sputum were improved. Additionally, an abnormal shadow in thoracic CT also completely diminished after receiving steroid. His respiratory failure completely recovered and AML was in complete remission. The man further received cytarabine [Ara-C] and methylprednisolone for preventing hemoptysis and never showed hemoptysis. He also showed cytogenetic complete remission for one and a half year. He had a relapse and received re-induction chemotherapy cytarabine, daunorubicin and methylprednisolone. He underwent allogeneic stem cell transplantation in the second complete remission. Finally, he achieved a complete molecular response without graft-versus-host disease and hemoptysis. Kanaya M, et al. Diffuse alveolar hemorrhage during induction therapy for acute myeloid leukemia with inv(16)(p13.1q22). International Journal of Hematology 112: 134-135, 803497989 No. 2, 06 Jun 2020. Available from: URL: http://doi.org/10.1007/s12185-020-02900-2

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Reactions 29 Aug 2020 No. 1819