Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 12, Number 7, July 2021, pages 295-299


Osimertinib-Induced Unilateral Diffuse Alveolar Hemorrhage in a Patient With Pulmonary Adenocarcinoma

Figures

Figure 1.
Figure 1. Chest computed tomography on the diagnosis (a), 2 months after the start of osimertinib (b) and on admission (c).
Figure 2.
Figure 2. Chest radiographs on 2 months after the initiation of osimertinib (a), on admission (b), and (c) at the time of extubation (on the hospital day 11).
Figure 3.
Figure 3. The BALFs on the hospital day 1 (a) and 9 (b). BALF: bronchoalveolar lavage fluid.

Table

Table 1. Summary of Previous Cases of Alveolar Hemorrhage Induced by EGFR-TKI
 
Author (year)EGFR-TKI (line)Age (years), sex, countrySymptomsMutationsIntervalaSteroid use (initial dose)Respiratory managementBFS (differential cell count)
aThe interval time from the start of EGFR-TKI to the onset of symptoms. EGFR-TKI: epidermal growth factor receptor tyrosine kinase inhibitor; Ex: exon; F: female; Gef: gefitinib; Lym: lymphocytes; M: male; mPSL: methylprednisolone; ND: not described; Neu: neutrophils; NPPV: non-invasive positive pressure ventilation; Osim: osimertinib; SQ: squamous carcinoma; BFS: bronchial fiberscope.
Ieki et al, 2003 [4]Gef (4th)56 M, JapanDyspnea, bloody phlegmND4 weeksHigh-dose mPSLNPPVPerformed (90% Lym, 10% Neu)
Yano et al, 2005 [5]Gef (4th)62 F, JapanNDND13 monthsmPSL (1,000 mg/day)NDND
Zhao et al, 2014 [6]Erl (1st)40 M, ChinaFeverEsophageal carcinoma (SQ)1 monthmPSL (1,000 mg/day)NPPVPerformed (ND)
Sakoda et al, 2011 [8]Gef (2nd)74 F, JapanEpistaxis, bloody phlegmND2 weeksNo steroidNasal O2Performed (ND)
Forte et al, 2019 [1]Osim (multiple)65 F, USADyspnea, fatigueEx19del,T790M5 monthsmPSL (1,000 mg/day)IntubatedPerformed (ND)
Komori et al, 2019 [7]Osim (2nd)75 F, JapanBloody phlegmL858R, T790M2 monthsPSL (0.5 mg/kg)NDPerformed (20% Lym, 8% Neu)
OursOsim (1st)70 M, JapanDyspneaEx19del4 monthsmPSL (1,000 mg/day)IntubatedPerformed (55% Lym, 44% Neu)