Diffuse Alveolar Hemorrhage Due to Drugs: Two Case Reports

We present here two cases who developed diffuse alveolar hemorrhage (DAH) after using inhaled anesthetic sevoflurane and warfarin as an anticoagulant. The first patient was a 32-year-old male who underwent general surgery for appendicitis, and who developed sudden hypoxemia and bleeding at the end of the operation. Bilateral diffuse alveolar infiltrates were identified on chest X-ray, and decreased serum hemoglobin in the postoperative period. The hypoxemia resolved on the fifth day, and alveolar infiltrates disappeared from the chest X-ray. The second case was prescribed Coumadin for the treatment of atrial fibrillation and was found to have an INR value of 12.6 upon presentation to the emergency department with a complaint of hemoptysis. The patient was administered intramuscular vitamin K, and the pulmonary infiltrates were noted to have regressed radiologically on the fifth day. Although DAH is rare with both drugs, early diagnosis and treatment can be lifesaving.

Ýlaçlara Baðlý Olarak Geliþen Diffüz Alveoler Hemoraji: Ýki Olgu Sunumu

Antikoagülan olarak inhale anestezik sevofluran ve varfarin kullanýmýna baðlý yaygýn alveoler kanama (DAH) geliþen iki olguyu sunmayý amaçladýk. Hastanýn ilki apandisit nedeniyle genel cerrahiye baþvuran 32 yaþýnda bir erkekti. Ameliyat sonunda ani hipoksemi ve kanama tespit edildi. Akciðer grafisinde bilateral diffüz alveoler infiltratlar görüldü. Postoperatif dönemde serum hemoglobin seviyesinde düþüþ gözlendi. Beþinci günde hipoksemi düzeldi ve akciðer grafisinde alveolar infiltratlar kayboldu. Ýkinci olgumuzda atriyal fibrilasyon nedeniyle coumadin kullanýlmýþ olup, acil servise hemoptizi þikayeti ile baþvuran hastanýn INR deðeri 12.6 idi. Hastaya intramusküler K vitamini verildi. Beþinci günde radyolojik olarak akciðer infiltratlarýnda gerileme gözlendi. Her iki ilaca baðlý DAH yaygýn olmasa da erken taný ve tedavi hayat kurtarýcý olabilir.