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Diffuse alveolar hemorrhage after use of a fluoropolymer-based waterproofing spray.

Kikuchi R, Itoh M, Uruma T, Tsuji T, Watanabe H, Nakamura H, Aoshiba K - Springerplus (2015)

Bottom Line: Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells associated with extreme neutrophilia.The patient was observed without corticosteroid therapy, and his symptoms and abnormal shadows on the chest radiographs and CT improved.Supportive treatment may be effective and sufficient.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395 Japan.

ABSTRACT
A 30-year-old man developed chills, cough and dyspnea a few minutes after using a fluoropolymer-based waterproofing spray in a small closed room. He visited our hospital 1 h later. Examination revealed that the patient had incessant cough, tachypnea, fever and decreased peripheral arterial oxygen saturation. Blood tests revealed leukocytosis with elevated serum C-reactive protein levels. Chest radiographs and computed tomography (CT) scan showed bilateral ground glass opacities, mainly in the upper lobes. Bronchoalveolar lavage (BAL) fluid obtained from the right middle lobe showed a bloody appearance. Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells associated with extreme neutrophilia. Microbiological studies of the BAL fluid were negative. The patient was observed without corticosteroid therapy, and his symptoms and abnormal shadows on the chest radiographs and CT improved. On day 7 after admission, the patient was discharged from the hospital. Accidental inhalation of waterproofing spray may cause diffuse alveolar hemorrhage, a rare manifestation of acute lung injury. Supportive treatment may be effective and sufficient.

No MeSH data available.


Related in: MedlinePlus

Bloody gross appearance (left) and microscopic findings (right) of bronchoalveolar lavage fluid specimens. Right May-Giemsa-stained cytospin preparation showing numerous red blood cells and neutrophils, consistent with the diagnosis of alveolar hemorrhage. Arrows macrophages. Scale bar 50 μm.
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Fig2: Bloody gross appearance (left) and microscopic findings (right) of bronchoalveolar lavage fluid specimens. Right May-Giemsa-stained cytospin preparation showing numerous red blood cells and neutrophils, consistent with the diagnosis of alveolar hemorrhage. Arrows macrophages. Scale bar 50 μm.

Mentions: A 30-year-old Japanese male, a smoker with no significant past medical, allergy or cocaine use history, developed chills, cough and dyspnea a few minutes after using a fluoropolymer-based waterproofing spray on his leather uniforms in a small closed room. He presented to our hospital 1 h later. Examination revealed that the patient had incessant cough, tachypnea (30 breaths per minute), fever (39.4°C) and slightly decreased peripheral arterial oxygen saturation [percutaneous oxygen saturation (SpO2): 92% on room air]; however, there were no lung crackles or wheeze. Examination of the cardiovascular system revealed no abnormalities. There was no weight loss, arthralgia or skin rash. As shown in Table 1, the blood tests revealed leukocytosis [20,300 cells/μL (normal, 4,000–8,000 cells/μL) with 91.5% neutrophils, 0% eosinophils and 6.5% lymphocytes], elevated serum C-reactive protein levels [3.14 mg/dL (normal, <0.3 mg/dL)] and elevated serum LDH levels [341 U/l (normal, 106–220 U/l)]. Autoimmune screening, including for anti-neutrophil cytoplasm antibody (ANCA) and anti-glomerular basement membrane (anti-GBM) antibody, revealed no autoantibodies. The serum brain natriuretic peptide (BNP) level and coagulation profile were normal. Urinalysis showed no proteinuria or hematuria. Chest radiographs and computed tomography (CT) scan showed bilateral ground glass opacities, mainly in the upper lobes (Figure 1). Fiberoptic bronchoscopy was performed 13 h after the onset of the symptoms. Bronchoalveolar lavage (BAL) fluid obtained from the right middle lobe showed a bloody appearance (Figure 2, left). While the upper lobes appeared to be predominantly involved, the middle lobe was selected for obtaining the BAL sample, because this lobe is the smallest and yields the largest return (Baughman 2007). Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells with extreme neutrophilia (differential neutrophil count 79.8%, normal range <3%) (Figure 2, right). The siderophage count was less than 2%. Microbiological studies of the BAL fluid were negative. The patient was observed without corticosteroid therapy, and his symptoms improved significantly by the day after admission. By day 7 after admission, the abnormal shadows on the chest radiographs and CT scan had almost completely disappeared and the patient was discharged from the hospital. At 6 months after discharge, his health status was normal. Consent to publish this case report was obtained from the patient.Table 1


Diffuse alveolar hemorrhage after use of a fluoropolymer-based waterproofing spray.

Kikuchi R, Itoh M, Uruma T, Tsuji T, Watanabe H, Nakamura H, Aoshiba K - Springerplus (2015)

Bloody gross appearance (left) and microscopic findings (right) of bronchoalveolar lavage fluid specimens. Right May-Giemsa-stained cytospin preparation showing numerous red blood cells and neutrophils, consistent with the diagnosis of alveolar hemorrhage. Arrows macrophages. Scale bar 50 μm.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4469595&req=5

Fig2: Bloody gross appearance (left) and microscopic findings (right) of bronchoalveolar lavage fluid specimens. Right May-Giemsa-stained cytospin preparation showing numerous red blood cells and neutrophils, consistent with the diagnosis of alveolar hemorrhage. Arrows macrophages. Scale bar 50 μm.
Mentions: A 30-year-old Japanese male, a smoker with no significant past medical, allergy or cocaine use history, developed chills, cough and dyspnea a few minutes after using a fluoropolymer-based waterproofing spray on his leather uniforms in a small closed room. He presented to our hospital 1 h later. Examination revealed that the patient had incessant cough, tachypnea (30 breaths per minute), fever (39.4°C) and slightly decreased peripheral arterial oxygen saturation [percutaneous oxygen saturation (SpO2): 92% on room air]; however, there were no lung crackles or wheeze. Examination of the cardiovascular system revealed no abnormalities. There was no weight loss, arthralgia or skin rash. As shown in Table 1, the blood tests revealed leukocytosis [20,300 cells/μL (normal, 4,000–8,000 cells/μL) with 91.5% neutrophils, 0% eosinophils and 6.5% lymphocytes], elevated serum C-reactive protein levels [3.14 mg/dL (normal, <0.3 mg/dL)] and elevated serum LDH levels [341 U/l (normal, 106–220 U/l)]. Autoimmune screening, including for anti-neutrophil cytoplasm antibody (ANCA) and anti-glomerular basement membrane (anti-GBM) antibody, revealed no autoantibodies. The serum brain natriuretic peptide (BNP) level and coagulation profile were normal. Urinalysis showed no proteinuria or hematuria. Chest radiographs and computed tomography (CT) scan showed bilateral ground glass opacities, mainly in the upper lobes (Figure 1). Fiberoptic bronchoscopy was performed 13 h after the onset of the symptoms. Bronchoalveolar lavage (BAL) fluid obtained from the right middle lobe showed a bloody appearance (Figure 2, left). While the upper lobes appeared to be predominantly involved, the middle lobe was selected for obtaining the BAL sample, because this lobe is the smallest and yields the largest return (Baughman 2007). Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells with extreme neutrophilia (differential neutrophil count 79.8%, normal range <3%) (Figure 2, right). The siderophage count was less than 2%. Microbiological studies of the BAL fluid were negative. The patient was observed without corticosteroid therapy, and his symptoms improved significantly by the day after admission. By day 7 after admission, the abnormal shadows on the chest radiographs and CT scan had almost completely disappeared and the patient was discharged from the hospital. At 6 months after discharge, his health status was normal. Consent to publish this case report was obtained from the patient.Table 1

Bottom Line: Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells associated with extreme neutrophilia.The patient was observed without corticosteroid therapy, and his symptoms and abnormal shadows on the chest radiographs and CT improved.Supportive treatment may be effective and sufficient.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395 Japan.

ABSTRACT
A 30-year-old man developed chills, cough and dyspnea a few minutes after using a fluoropolymer-based waterproofing spray in a small closed room. He visited our hospital 1 h later. Examination revealed that the patient had incessant cough, tachypnea, fever and decreased peripheral arterial oxygen saturation. Blood tests revealed leukocytosis with elevated serum C-reactive protein levels. Chest radiographs and computed tomography (CT) scan showed bilateral ground glass opacities, mainly in the upper lobes. Bronchoalveolar lavage (BAL) fluid obtained from the right middle lobe showed a bloody appearance. Microscopic examination of a BAL cytospin specimen revealed the presence of numerous red blood cells associated with extreme neutrophilia. Microbiological studies of the BAL fluid were negative. The patient was observed without corticosteroid therapy, and his symptoms and abnormal shadows on the chest radiographs and CT improved. On day 7 after admission, the patient was discharged from the hospital. Accidental inhalation of waterproofing spray may cause diffuse alveolar hemorrhage, a rare manifestation of acute lung injury. Supportive treatment may be effective and sufficient.

No MeSH data available.


Related in: MedlinePlus