DIFFUSE ALVEOLAR HEMORRHAGE: A RARE COMPLICATION OF ACUTE MYELOID LEUKEMIA

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary syndrome affecting individuals with hematologic malignancies increased incidence post bone marrow transplant. We present rare case DAH presumably related to leukemic infiltration (PLI) in newly diagnosed Acute Myelogenous Leukemia (AML) patient. CASE PRESENTATION: A 55-year-old female, previously healthy, presented the emergency room 1-week history dyspnea, cough, and epistaxis. Laboratory data were relevant for leukocytosis (WBC 150,000/mm3) 84% blasts, thrombocytopenia (platelets 15,000/mm3), anemia (Hb 8.9 g/dL). CT angiography chest was negative embolism but showed scattered bilateral ground-glass opacities (GGO). Peripheral blood flow cytometry revealed AML. She underwent leukapheresis an appropriate response. On day 5 admission, she transferred intensive care unit oxygen requirement required endotracheal intubation after. Chest significant worsening GGO septal thickening. WBC 27,000/mm3, Hb 7.7 g/dL, platelets 50,000/mm3. Bronchoscopy serial bronchoalveolar lavages (BAL) increasingly bloody return. BAL cell differential 75% blasts. treated platelet transfusion, nebulized tranexamic acid, high dose corticosteroids, empiric antibiotic therapy. Emergent induction chemotherapy (daunorubicin + cytarabine) started. Repeat bronchoscopy 48h resolution undetectable blasts BAL. extubated on 7 post-intubation, her respiratory status improved back baseline. DISCUSSION: leukemia may be result infectious process, edema, drug toxicity, diffuse hemorrhage, intravascular leukostasis, or infiltrates. Though timing complications, clinical presentation, findings help identify etiology, diagnosis frequently challenging, early benefit. In this patient, infiltrates despite excluded leukostasis suggested PLI. Hemoptysis absent more than one-third patients DAH. had no hemoptysis, subsequently bronchoscopy. believe that PLI, excellent response chemotherapy, along other supportive measures led favorable outcome. CONCLUSIONS: Early recognition acute failure etiology essential. Albeit rare, should always as identification treatment can likely improve outcomes. REFERENCE #1: Nanjappa S, Jeong DK, Muddaraju M, K, Hill ED, Greene JN. Alveolar Hemorrhage Myeloid Leukemia. Cancer Control. 2016 Jul;23(3):272-7 #2: Nucci Nouér SA, Anaissie E. Distinguishing Causes Infiltrates Patients Clin Lymphoma Myeloma Leuk. 2015 Jun;15 Suppl: S98-103. DISCLOSURES: No relationships by Tony Abdo, source=Web Response Samiksha Gupta, SYED HUSSAIN, Miloni Parmar,