RESUMO
A 66-year-old man was admitted to our hospital for gastrointestinal perforation. He had a history of surgery and chemotherapy for colorectal cancer and had a subcutaneously implanted central venous port catheter. After surgery for gastrointestinal tract perforation, he developed an intra-abdominal abscess, which was treated with broad-spectrum antimicrobial agents and improved. Following this improvement, Rhodotorula spp. was detected in a blood culture and at the catheter tip. He was asymptomatic despite having fungemia. His condition improved after the removal of the catheter and the administration of antifungal drugs. Fungemia due to Rhodotorula spp. is rare, and asymptomatic fungemia is even rarer.
Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Fungemia , Rhodotorula , Idoso , Antifúngicos/uso terapêutico , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Fungemia/tratamento farmacológico , Humanos , MasculinoRESUMO
A 39-year-old man treated with dasatinib for chronic myelogenous leukaemia presented to our hospital with haemoptysis, coughing, and dyspnoea. Chest radiography and computed tomography revealed ground-glass opacities and a crazy-paving pattern. Bronchoalveolar lavage was not performed due to serious hypoxemia and bleeding. Significant bleeding from the peripheral bronchi led to a diagnosis of an alveolar haemorrhage. Dasatinib-induced alveolar haemorrhaging was suspected based on the clinical findings. His condition improved immediately after dasatinib withdrawal and initiation of steroid therapy. Reports of alveolar haemorrhaging induced by dasatinib are rare. As such, this is considered an important case.
Assuntos
Dasatinibe/uso terapêutico , Hemorragia/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Proteinose Alveolar Pulmonar/diagnóstico , Adulto , Tosse/etiologia , Dasatinibe/efeitos adversos , Diagnóstico Diferencial , Dispneia/etiologia , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Inibidores de Proteínas Quinases/efeitos adversos , Proteinose Alveolar Pulmonar/induzido quimicamente , Proteinose Alveolar Pulmonar/complicações , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Although drug-induced interstitial pneumonitis caused by gefitinib is well recognized in Japan, reports of alveolar hemorrhage caused by gefitinib are very rare. We encountered a case of alveolar hemorrhage thought to be caused by gefitinib. A 74-year-old woman with non-small cell lung cancer (adenocarcinoma; cT4NOM0, stage IIIB) had been receiving gefitinib as second-line therapy from January 2009. However, bloody sputum and nasal bleeding were observed 2 weeks after the initiation of gefitinib therapy. Chest radiography and computed tomography revealed ground-glass opacities predominantly in the lower lung fields. Bronchoscopy was performed, and the bronchoalveolar lavage fluid obtained from the right B8 was bloody. Her symptoms and chest ground-glass opacities improved after the withdrawal of gefitinib. Based on these clinical findings, we diagnosed alveolar hemorrhage caused by gefitinib. If chest radiography or computed tomography findings of gefitinib-treated patients show ground-glass opacities, the possibility of not only interstitial pneumonitis, but also alveolar hemorrhage should be considered in the differential diagnosis.