Sequential adjuvant chemoradiotherapy-induced diffuse alveolar haemorrhage in a patient with breast cancer successfully treated with corticosteroid plus recombinant human soluble thrombomodulin

BMJ Case Rep. 2016 Oct 28:2016:bcr2016217183. doi: 10.1136/bcr-2016-217183.

Abstract

The effective treatment for corticosteroid (CS)-refractory sequential chemoradiotherapy (CRT)-induced lung injury has not been established. We report a case of sequential CRT-induced diffuse alveolar haemorrhage (DAH) successfully treated with CS therapy plus recombinant human soluble thrombomodulin (rhTM). A 69-year-old woman was treated with sequential adjuvant CRT for early-stage breast cancer. After sequential CRT, she suffered from progressive dyspnoea. Chest CT scan showed consolidations in the irradiation field and diffuse ground-glass attenuations in the non-irradiation regions. We suspected sequential CRT-induced DAH because of increased haemosiderin-laden macrophages in bronchoalveolar lavage fluid. Her clinical conditions did not improve with high-dose CS therapy. Therefore, rhTM was added, and her disease and serum high-mobility group box-1 levels improved rapidly. Therefore, rhTM plus CS might be a safe and effective treatment for sequential CRT-induced lung injury, although further study is necessary to validate these findings.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / therapy*
  • Aged
  • Breast Neoplasms / therapy*
  • Chemoradiotherapy, Adjuvant / adverse effects*
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / therapeutic use
  • Hemorrhage / drug therapy*
  • Hemorrhage / etiology
  • Humans
  • Lung Diseases / drug therapy*
  • Lung Diseases / etiology
  • Methylprednisolone / therapeutic use*
  • Pulmonary Alveoli
  • Recombinant Proteins / therapeutic use
  • Thrombomodulin / therapeutic use*

Substances

  • Glucocorticoids
  • Recombinant Proteins
  • Thrombomodulin
  • Methylprednisolone