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• W4387248912 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Diffuse alveolar hemorrhage (DAH) is a rare and fatal pulmonary condition caused due to disruption in the alveolar-capillary basement membrane [1]. Upon literature review, it was found that hemoptysis is the most common presenting symptom, but hemoptysis is not always seen in all patients. We present a case of sepsis and pneumonia in a 73 year old male who during the course of hospitalization developed DAH as a complication of myelodysplastic syndrome (MDS). CASE PRESENTATION: A 73 year old male patient was admitted to the ICU for sepsis due to pneumonia and was treated with empiric antibiotic therapy and supplemental oxygen with non-invasive ventilation. Three weeks prior, he was diagnosed with MDS and received first cycle of chemotherapy. He had dry cough on presentation and did not report hemoptysis. Labs were remarkable for leukopenia, anemia and thrombocytopenia. He was stabilized, weaned off oxygen and downgraded to the medical floor. Unfortunately his respiratory status continued to decline with increasing oxygen requirements. CT chest at the time demonstrated development of diffuse, ground glass infiltrates in bilateral lung fields. He was readmitted to the ICU and intubated due to severe ARDS. A bronchoscopy was done which showed sequentially progressing hemorrhagic effluent which was diagnostic of diffuse alveolar hemorrhage, confirmed on broncho-alveolar lavage studies. Due to ongoing blood loss from alveolar hemorrhage and hemodynamic instability, he was transfused with a total of 18 units of platelets. Eventually, his condition worsened with severe thrombocytopenia and increasing oxygen requirements. He was eventual compassionately extubated after pursuing comfort measures per family's wishes DISCUSSION: DAH can be a manifestation of paraneoplastic phenomenon such as paraneoplastic vasculitis in MDS. Autoimmune paraneoplastic phenomena are seen in around 30% of patients [2]. We included a broad differential for this patient including HLH considering pancytopenia, hospital acquired pneumonia, drug induced alveolar hemorrhage and other autoimmune vasculitides. Considering absence of confirmed infectious source, worsening edema, increasing infiltrates, our patient most likely developed DAH as a complication/paraneoplastic presentation of MDS. Literature review confirmed that our patient's presentation was similar to that outlined by Enright et al [3]. In this study, 30 patients with MDS were included among whom 5 had pulmonary infiltrates consistent with DAH. Typically, DAH associated with MDS responds to high dose IV steroids in patients with paraneoplastic vasculitis CONCLUSIONS: This case highlights the importance of considering rare diagnoses such as DAH among the differential in patients with MDS and progressive, diffuse infiltrates and worsening hypoxia as it is typically fatal. Given that this condition carries a high mortality risk, early diagnosis and management is key to survival. REFERENCE #1: 1. Abigail R. Lara, Marvin I. Schwarz, Diffuse Alveolar Hemorrhage, Chest, Volume 137, Issue 5 2010, Pages 1164-1171, ISSN 0012-3692 REFERENCE #2: 2. Jagadish PS, Uhelski AR, Redfield J, Thomson N, Ogbeide O. The Pulmonary Complications of Paraneoplastic Autoimmune Vasculitis in a Patient With Myelodysplastic Syndrome. Cureus. 2020 Jul 19;12(7):e9282. doi: 10.7759/cureus.9282. PMID: 32821625; PMCID: PMC7431304 REFERENCE #3: 3. Enright H, Jacob HS, Vercellotti G, Howe R, Belzer M, Miller W. Paraneoplastic autoimmune phenomena in patients with myelodysplastic syndromes: response to immunosuppressive therapy. Br J Haematol. 1995 Oct;91(2):403-8. doi: 10.1111/j.1365-2141.1995.tb05310.x. PMID: 8547082. DISCLOSURES: No relevant relationships by Tiffany Downs No disclosure on file for Abiy Kelil No relevant relationships by Besham Kumar No relevant relationships by Sanjana Nethagani" @default.
• W4387248912 created "2023-10-03" @default.
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• W4387248912 date "2023-10-01" @default.
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• W4387248912 title "DIFFUSE ALVEOLAR HEMORRHAGE AS A FATAL COMPLICATION OF MYELODYSPLASTIC SYNDROME: A CASE REPORT" @default.
• W4387248912 doi "https://doi.org/10.1016/j.chest.2023.07.2182" @default.
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