Pulmonary Hemorrhage: Case Reports
The radiographic abnormalities progressed to extensive diffuse bilateral alveolar infiltrates (Fig 1), precipitating respiratory failure requiring intubation and mechanical ventillation. Laboratory data at that time disclosed the following values: hematocrit, 25.3%; prothrombin time (PT), 13.1 s; partial thromboplastin time (PTT), 41 s; platelet count, 41,000/mm; serum urea nitrogen, 56 mg/dL; and creatinine, 9.0 mg/dL. Radiographic progression of the infiltrates prompted the addition of empiric amphotericin В and methylprednisilone.
On the ninth hospital day, fiberoptic bronchoscopy with bilateral bronchoalveolar lavage (BAL) demonstrated return of persistently grossly bloody fluid. No endobronchial lesions were observed. Examination of the BAL specimen failed to demonstrate the presence of routine bacteria, P carinii, fungal elements, or AFB by special stains and cultures. Cytologic examination demonstrated hemosiderin-laden macrophages (Fig 2). read only
With no evidence for a new pulmonary infectious process, treatment with corticosteroids, amphotericin B, and tri-methoprim-sulfamethoxazole was discontinued. The patient received blood products and supportive therapy. Although the platelet count remained low, serum creatinine concentration improved to a value of 5.2 mg/dL. The patient demonstrated clinical and radiographic improvement and was successfully extu-bated within 4 days of initial intubation. This 44-year-old homosexual male nonsmoker, with a history of hepatitis В infection and recurrent thoracic herpes zoster, was determined to have positive HIV serology test results 36 months PTA. Fifteen months PTA he developed fever, nausea, vomiting, rectal pain, and abnormal results of liver function tests.
Figure 1. Chest radiograph at the time of fiberoptic bronchoscopy demonstrating bilateral diffuse alveolar infiltrates.
Figure 2. High-power light photomicrograph (original magnification X600) of a cytology smear from a BAL specimen demonstrates hemosiderin-laden macrophages (arrow). The cell pellet was isolated from the BAL fluid by centrifugation. A portion of the cell pellet was applied onto a slide, fixed in 95% ethanol, and stained by Paponicolou method.
Category: Respiratory Symptoms
Tags: AIDS, alveolar hemorrhage, pulmonary infiltrates