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High fever and multi-nodular lung consolidations after whole lung lavage in a patient with pulmonary alveolar proteinosis.

Zhang S, Wang Y, Xu Z, Ding L, Wang L, Li L, Zhang G - Springerplus (2015)

Bottom Line: After therapies like liquid limitation, glucocorticoid administration and diuretic treatment, the patient was improved gradually.Namely, newly nodular consolidations were almost completely absorbed in three days, along with the complete recovery of body temperature and associated inflammatory biomarkers.As the obvious differences in treatments, it is very important for physicians to differentiate it from secondary infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Binjiang Branch, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 China.

ABSTRACT

Introduction: Whole lung lavage is the most effective method to treat pulmonary alveolar proteinosis (PAP), and most potential complications occur often during the lavage process, but few happen after lavage. Theoretically, pulmonary edema would be more common after whole lung lavage. However, no such case was reported in the literature.

Case description: A 47-year-old Chinese male patient with PAP was referred to our hospital for whole lung lavage treatment. Although the clinical manifestations of PAP were improved, high fever was happened and multi-nodular consolidations in chest CT scan were occurred after whole lung lavage. Secondary lung infection was suspected, but the patient was not treated with antibiotics immediately. After therapies like liquid limitation, glucocorticoid administration and diuretic treatment, the patient was improved gradually. Namely, newly nodular consolidations were almost completely absorbed in three days, along with the complete recovery of body temperature and associated inflammatory biomarkers. The diagnosis of secondary infection was excluded, and the final diagnosis of lavage fluid-induced pulmonary edema was confirmed.

Discussion and evaluation: No such case has been reported that lavage fluid-induced pulmonary edema is manifested by high fever and multi-consolidations in chest CT scan, which is similar to the secondary infection.

Conclusions: For the first time, we described a rare complication of lavage fluid-induced pulmonary edema after whole lung lavage. As the obvious differences in treatments, it is very important for physicians to differentiate it from secondary infection.

No MeSH data available.


Related in: MedlinePlus

Chest CT image performed one day after the whole lung lavage showing newly multi-nodular consolidations (black arrow) and patchy opacities in both posterior segments of lower lobes.
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Fig2: Chest CT image performed one day after the whole lung lavage showing newly multi-nodular consolidations (black arrow) and patchy opacities in both posterior segments of lower lobes.

Mentions: The patient was extubated on the second day in ICU, but high fever was occurred. The body temperature was between 39.0 and 40.0°C. Blood routine test, blood and sputum cultures, and chest CT scan were performed rapidly. The white blood cell count was normal with a high percentage (95.2%) of neutrophils. In addition, newly multi-nodular consolidations occurred in both posterior segments of lower lobes in chest CT scan (Figure 2). A possible diagnosis of secondary lung infection cannot be excluded completely, but the patient was not treated by broad-spectrum antibiotics immediately and observed closely for vital signs. At the same time, treatments like liquid limitation, glucocorticoid administration and diuretic treatment were continued. The patient’s condition was improved gradually. The body temperature was returned to normal level three days later. Importantly, multi-nodular lung consolidations were absorbed almost completely in chest CT scan (Figure 3). There was no bacterial/fungi growth from samples of blood, sputum and lavage fluid. The value of C-reactive protein (CRP) was dropped from high level of 223.9 mg/L to 10.5 mg/L (normal range, < 10 mg/L), and procalcitonin (PCT) was also recovered from 0.71 ng/mL to normal level of 0.10 ng/mL (normal range, < 0.5 ng/mL). The secondary infection was excluded, and the final diagnosis of lavage-induced pulmonary edema was confirmed. The patient was asymptomatic at discharge two weeks later with improved SpO2 (93.0 ~ 95.0% in room air), and remained well within six months of follow-up after discharge.Figure 2


High fever and multi-nodular lung consolidations after whole lung lavage in a patient with pulmonary alveolar proteinosis.

Zhang S, Wang Y, Xu Z, Ding L, Wang L, Li L, Zhang G - Springerplus (2015)

Chest CT image performed one day after the whole lung lavage showing newly multi-nodular consolidations (black arrow) and patchy opacities in both posterior segments of lower lobes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4322056&req=5

Fig2: Chest CT image performed one day after the whole lung lavage showing newly multi-nodular consolidations (black arrow) and patchy opacities in both posterior segments of lower lobes.
Mentions: The patient was extubated on the second day in ICU, but high fever was occurred. The body temperature was between 39.0 and 40.0°C. Blood routine test, blood and sputum cultures, and chest CT scan were performed rapidly. The white blood cell count was normal with a high percentage (95.2%) of neutrophils. In addition, newly multi-nodular consolidations occurred in both posterior segments of lower lobes in chest CT scan (Figure 2). A possible diagnosis of secondary lung infection cannot be excluded completely, but the patient was not treated by broad-spectrum antibiotics immediately and observed closely for vital signs. At the same time, treatments like liquid limitation, glucocorticoid administration and diuretic treatment were continued. The patient’s condition was improved gradually. The body temperature was returned to normal level three days later. Importantly, multi-nodular lung consolidations were absorbed almost completely in chest CT scan (Figure 3). There was no bacterial/fungi growth from samples of blood, sputum and lavage fluid. The value of C-reactive protein (CRP) was dropped from high level of 223.9 mg/L to 10.5 mg/L (normal range, < 10 mg/L), and procalcitonin (PCT) was also recovered from 0.71 ng/mL to normal level of 0.10 ng/mL (normal range, < 0.5 ng/mL). The secondary infection was excluded, and the final diagnosis of lavage-induced pulmonary edema was confirmed. The patient was asymptomatic at discharge two weeks later with improved SpO2 (93.0 ~ 95.0% in room air), and remained well within six months of follow-up after discharge.Figure 2

Bottom Line: After therapies like liquid limitation, glucocorticoid administration and diuretic treatment, the patient was improved gradually.Namely, newly nodular consolidations were almost completely absorbed in three days, along with the complete recovery of body temperature and associated inflammatory biomarkers.As the obvious differences in treatments, it is very important for physicians to differentiate it from secondary infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Binjiang Branch, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 China.

ABSTRACT

Introduction: Whole lung lavage is the most effective method to treat pulmonary alveolar proteinosis (PAP), and most potential complications occur often during the lavage process, but few happen after lavage. Theoretically, pulmonary edema would be more common after whole lung lavage. However, no such case was reported in the literature.

Case description: A 47-year-old Chinese male patient with PAP was referred to our hospital for whole lung lavage treatment. Although the clinical manifestations of PAP were improved, high fever was happened and multi-nodular consolidations in chest CT scan were occurred after whole lung lavage. Secondary lung infection was suspected, but the patient was not treated with antibiotics immediately. After therapies like liquid limitation, glucocorticoid administration and diuretic treatment, the patient was improved gradually. Namely, newly nodular consolidations were almost completely absorbed in three days, along with the complete recovery of body temperature and associated inflammatory biomarkers. The diagnosis of secondary infection was excluded, and the final diagnosis of lavage fluid-induced pulmonary edema was confirmed.

Discussion and evaluation: No such case has been reported that lavage fluid-induced pulmonary edema is manifested by high fever and multi-consolidations in chest CT scan, which is similar to the secondary infection.

Conclusions: For the first time, we described a rare complication of lavage fluid-induced pulmonary edema after whole lung lavage. As the obvious differences in treatments, it is very important for physicians to differentiate it from secondary infection.

No MeSH data available.


Related in: MedlinePlus