Respir Case Rep. 2016; 5(1): 43-48 | DOI: 10.5505/respircase.2016.86658

INTERACTIVE CASE REPORT: Sevoflurane-related Isolated Pulmonary Vasculitis: A New Etiological Cause of Diffuse Alveolar Hemorrhage?

Ufuk Turhan¹, Mehmet Aydoðan², Erol Kýlýç³, Hatice Kaya¹, Alper Gündoðan⁴, Yýldýrým Karslýoðlu⁵, Ergün Uçar¹, Hayati Bilgiç^1
1Department of Pulmonology, Gülhane Military Medical Academy, Ankara, Turkey
²Clinic of Pulmonology, Isparta Military Hospital, Isparta, Turkey
³Clinic of Pulmonology, Kasýmpaþa Military Hospital, Ýstanbul, Turkey
⁴Clinic of Pulmonology, Diyarbakýr Military Hospital, Diyarbakýr, Turkey
⁵Department of Pathology, Gülhane Military Medical Academy, Ankara, Turkey

Pulmonary capillaritis is the small-vessel vasculitis of the lungs. We report a case of isolated pulmonary capillaritis presenting with diffuse alveolar hemorrhage, which is not associated with ANCA. The patient had shortness of breath that developed after myomectomy surgery: sevoflurane was used as a general anesthetic in the operation. The thorax HRCT scans showed ground glass opacities in both lungs and consolidation in the right lower lobe. Due to hemorrhagic and darkening of the BAL fluid as aspirated, it was thought that the diagnosis was in accordance with alveolar hemorrhage. The patient responded well to methylprednisolone therapy. The transbronchial lung biopsies revealed vasculitis. ANCA and other rheumatologic markers were negative. Due to the absence of systemic symptoms, we diagnosed ANCA negative isolated pulmonary capillaritis. Rapid diagnosis and pulse steroid therapy are of vital importance in these patients. It should be kept in mind that inhalation anesthetics could be responsible for cases of DAH and SPC.

Keywords: Diffuse alveolar hemorrhage, isolated pulmonary capillaritis, sevoflurane

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ÝNTERAKTÝF OLGU SUNUMU: Sevofluran'a Baðlý Ýzole Pulmoner Vaskülit: Yaygýn Pulmoner Hemorajinin Yeni bir Nedeni mi?

Ufuk Turhan¹, Mehmet Aydoðan², Erol Kýlýç³, Hatice Kaya¹, Alper Gündoðan⁴, Yýldýrým Karslýoðlu⁵, Ergün Uçar¹, Hayati Bilgiç^1
1Gülhane Askeri Týp Akademisi, Göðüs Hastalýklarý Anabilim Dalý, Ankara
²Isparta Asker Hastanesi, Göðüs Hastalýklarý Kliniði, Isparta
³Kasýmpaþa Asker Hastanesi, Göðüs Hastalýklarý Kliniði, Ýstanbul
⁴Diyarbakýr Asker Hastanesi, Göðüs Hastalýklarý Kliniði, Diyarbakýr
⁵Gülhane Askeri Týp Akademisi, Patoloji Anabilim Dalý, Ankara

Pulmoner kapillerit akciðerin küçük damarlarýnýn vaskülitidir. Kollajen vasküler hastalýk ya da ANCA iliþkili vaskülitlerin parçasý olarak, izole pauci-immün kapillerit veya akciðer transplant rejeksiyonunda görülebilir. Biz, ANCA iliþkili olmayan ve sistemik tutulum göstermeyen, diffüz alveoler hemoraji (DAH) tablosu ile prezente olan “Ýzole Pulmoner Kapillerit (ÝPK)” olgusunu sunuyoruz. Miyomektomi operasyonu sonrasý geliþen nefes darlýðýyla konsülte edilen hastaya, operasyonda genel anestezik olarak sevofluran
kullanýlmýþtý. Derin hipoksik hastanýn toraks HRCT’sinde her iki akciðerde yaygýn buzlu cam alanlarý, sað akciðer alt lobda konsolidasyon izlendi. BAL materyalinin hemorajik ve aspire ettikçe renginin koyulaþmasý nedeniyle alveoler hemoraji olarak deðerlendirildi.
Metilprednizolon tedavisine iyi yanýt alýndý. Transbronþial akciðer biyopsileri vaskülit olarak raporlandý. ANCA’lar, diðer romatolojik belirteçler negatifti. Olgumuzun sistemik bulgularý olmadýðý için, ANCA negatif Ýzole Pulmoner Kapillerit olarak deðerlendirildi. Hýzlý taný ve pulse steroid baþlanmasý bu hastalarda hayati öneme sahiptir, gecikmeler hayati riskli olabilir. Literatürde yeterli kanýt yoksa da inhalasyon anesteziklerinin postoperatif dönemde oluþabilecek DAH ve ÝPK olgularýndan sorumlu olabileceði akýlda tutulmalýdýr.

Anahtar Kelimeler: Diffüz alveoler hemoraji, izole pulmoner kapillerit, sevofluran.

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Image Slices of the Case

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