0
Correspondence |

Remembering Other Causes of Alveolar Siderophages : Macrophage Activation Syndrome FREE TO VIEW

Alfredo N. C. Santana, MD; Ronaldo A. Kairalla, PhD; Carlos R. R. Carvalho, PhD
Author and Funding Information

University of São Paulo Medical School, Pulmonary Division and PSM-HC/PS-HU, São Paulo, Brazil

Correspondence to: Alfredo N. C. Santana, MD, Rua Oscar Freire, 2121, ap602, CEP:05409-011, São Paulo, SP, Brazil; e-mail: alfredonicodemos@hotmail.com



Chest. 2008;133(4):1055. doi:10.1378/chest.07-2668
Text Size: A A A
Published online

To the Editor:

We read the interesting article of Dr. Ksienski and colleagues1 that talks about cocaine, pulmonary edema, and siderophages. These cells are hemosiderin-laden alveolar macrophages characteristically found in BAL fluid or lung biopsy from patients with diffuse alveolar hemorrhage. Classically, diffuse alveolar hemorrhages are classified based on histologic appearance as capillaritis (Wegener granulomatosis, systemic lupus erythematosus, and propylthiouracil related), bland hemorrhage (coagulopathies, congestive heart failure, and rapamycin related), diffuse alveolar damage (ARDS and Crack cocaine inhalation), and miscellaneous conditions (lymphangioleiomyomatosis and pulmonary capillary hemangiomatosis).

However, we consider that macrophage activation syndrome should be included in the differential diagnosis of alveolar siderophages.25 Macrophage activation syndrome is a rare disease characterized by an immune dysregulation with excessive hemophagocytosis in lung/bone marrow/spleen (producing hemosiderin-laden macrophages), splenomegaly, bicytopenia, hypertriglyceridemia, hyperferritinemia > 500 μg/L, low natural killer-cell activity, increased plasma serum CD25, and fever.2In addition, macrophage activation syndrome usually occurs in response to a triggering agent, such as tumors or infections (especially Epstein-Barr virus). Furthermore, macrophage activation syndrome may present with the triad of diffuse alveolar hemorrhage (lung infiltrates, a falling hemoglobin level, and worsening dyspnea).35 Therefore, chest physicians and pathologists should remember macrophage activation syndrome in patients with pulmonary infiltrates and falling hemoglobin levels and/or alveolar siderophages.

The authors have no conflicts of interest to disclose.

Ksienski, D, Malhotra, S, Walker, B, et al (2007) Chest pain and cough in a 33-year-old postpartum woman.Chest132,1389-1392. [PubMed] [CrossRef]
 
Emmenegger, U, Schaer, DJ, Larroche, C, et al Haemophagocytic syndromes in adults: current concepts and challenges ahead.Swiss Med Wkly2005;135,299-314. [PubMed]
 
Popper, HH, Zenz, W, Mache, C, et al Familial haemophagocytic lymphohistiocytosis: a report of three cases with unusual lung involvement.Histopathology1994;25,439-445. [PubMed]
 
Tateishi, U, Nishihara, H, Okano, M, et al High resolution CT findings of macrophage activation syndrome: a case report.Pediatr Radiol2000;30,699-701. [PubMed]
 
Brandao-neto RA, Santana ANC, Danilovic DLS, et al. A very rare cause of dyspnea with a unique presentation on chest CT: macrophage activation syndrome. J Bras Pneumol 2008 (in press).
 

Figures

Tables

References

Ksienski, D, Malhotra, S, Walker, B, et al (2007) Chest pain and cough in a 33-year-old postpartum woman.Chest132,1389-1392. [PubMed] [CrossRef]
 
Emmenegger, U, Schaer, DJ, Larroche, C, et al Haemophagocytic syndromes in adults: current concepts and challenges ahead.Swiss Med Wkly2005;135,299-314. [PubMed]
 
Popper, HH, Zenz, W, Mache, C, et al Familial haemophagocytic lymphohistiocytosis: a report of three cases with unusual lung involvement.Histopathology1994;25,439-445. [PubMed]
 
Tateishi, U, Nishihara, H, Okano, M, et al High resolution CT findings of macrophage activation syndrome: a case report.Pediatr Radiol2000;30,699-701. [PubMed]
 
Brandao-neto RA, Santana ANC, Danilovic DLS, et al. A very rare cause of dyspnea with a unique presentation on chest CT: macrophage activation syndrome. J Bras Pneumol 2008 (in press).
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543