Lung Cancer |

Leukemic Pulmonary Infiltrates as a Cause of Acute Respiratory Failure FREE TO VIEW

Khalid Sherani, MD; Sidhertha Podder, MBBS; Aashir Shah, MBBS; Abhay Vakil, MBBS; Kelly Cervellione, MPH; Mahendra Patel, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Chest. 2015;148(4_MeetingAbstracts):531A. doi:10.1378/chest.2250948
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SESSION TITLE: Lung Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary complications are known to be one of the major causes of death in leukemic patients. Pulmonary infections account for most of these complications while symptomatic leukemic involvement of the lung is rarely seen. We present case of a 63-year-old female presenting with gingival bleeding and shortness of breath. Imaging studies showed bilateral diffuse ground glass infiltrates. Hematologic workup revealed acute monocytic leukemia. Histopathologic examination of lung tissue obtained via open lung biopsy revealed diffuse interstitial and perivascular infiltration of blast cells in the lung tissue suggestive of leukemic pulmonary infiltration as cause of his respiratory failure.

CASE PRESENTATION: A 63-year-old female with no significant medical history presented with sudden onset shortness of breath, gingival swelling and bleeding. She also complained of malaise and 25 pounds weight loss over the last 3 months. She was tachypneic, tachycardic and hypoxic requiring intubation. Examination revealed diffuse bilateral crepitations. Laboratory studies are shown in table 1. Imaging studies revealed diffuse ground glass opacities (Fig.1a). Bronchoscopy with lavage failed to show alveolar haemorrhage or infection as cause of her respiratory failure. Her respiratory status continued to deteriorate on antibiotic and anti-leukemic therapy, inspite of decreasing leukocyte count. An open lung biopsy was performed showing diffuse interstitial and perivascular infiltration of blast cells in the lung tissue suggestive of leukemic pulmonary infiltration (Fig.1b). Her respiratory status continued to deteriorate with improving leukocyte counts ultimately leading to death.

DISCUSSION: Diagnosis of pulmonary leukemic infiltration is established with cytologic or pathologic findings after exclusion of other common causes. It has a very nonspecific and variable radiographic appearance. Patients can experience worsening respiratory status after initial chemotherapy due to acute lysis of leukemic cells that cause worsening pulmonary inflammation. Such patients have extremely poor prognosis and pre-induction leukapheresis might be helpful.

CONCLUSIONS: Pulmonary leukemic infiltration should be considered in all the patients with leukemia having an abnormal chest radiograph and negative cultures; especially in the presence of high or rapidly increasing blast counts.

Reference #1: Wu YK, Huang YC, Huang SF et al. Acute respiratory distress syndrome caused by leukemic infiltration of the lung. J Formosan Med Assoc. 2008 May;107(5):419-23.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Sidhertha Podder, Aashir Shah, Abhay Vakil, Kelly Cervellione, Mahendra Patel

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