Correct!
1. Acute lysis pneumopathy
Any of the diagnosis is possible. However, acute lysis pneumopathy is the best choice (5,6). This occurs when lysis of leukemic cells in the lung tissue release potentially harmful enzymes and possible other substances leading to diffuse alveolar damage (ARDS). Acute lysis pneumopathy usually occurs simultaneously with tumor lysis syndrome. The frequency of occurrence is unclear with it being described to occur “occasionally” up to 100% patients in one series (6).
It has been postulated that steroids may prevent acute lysis pneumopathy (6). Twenty patients with this disorder were given 10mg dexamethasone every 6 hours, and compared to historical controls had lower ICU mortality rate (20% vs. 50%), less respiratory deterioration after chemotherapy (50% vs. 80%) and no significant increases in infection.
Our patient was begun on dexamethasone, diuresed and continued on antibiotics. He clinically improved with his oxygen requirements decreasing to 2 L/min by nasal cannula and his chest x-ray improved (Figure 5).
Figure 5. Portable AP of chest 2 days after beginning dexamethasone and diuresis.
Bridgett Ronan has contributed several cases of our Case of the Month series. She is completing her fellowship and this case is her “Swan Song” as a fellow.
References