Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Department on Internal Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Am J Health Syst Pharm. 2021 Jul 9;78(14):1277-1281. doi: 10.1093/ajhp/zxab156.
A case of diffuse alveolar hemorrhage (DAH) occurring as a reaction to ustekinumab therapy is reported.
After starting ustekinumab for treatment of psoriatric arthritis, a 46-year-old female presented with flu-like symptoms and cough with blood-tinged sputum that had begun 1 week previously. Her initial computed tomography scan of the chest demonstrated bilateral ground-glass opacities. On bronchoscopy, the bronchoalveolar lavage (BAL) return became bloodier from sample 1 to samples 2 and 3. Her BAL fluid was more than 90% hemosiderin-laden macrophages, a finding consistent with DAH. We ruled out infectious etiologies and other common vasculitis conditions that can cause DAH. A diagnosis of ustekinumab-induced DAH was made due to a temporal relationship between initiation of the drug and the patient's presentation and the absence of infection and other alternate diagnosis. Prior case reports including ustekinumab-induced pneumonitis, interstitial lung disease with a granulomatous component, and lupus syndrome have been reported, with this being the first case of DAH in a patient undergoing treatment of psoriatic arthritis.
A 46-year-old woman developed DAH during ustekinumab treatment. Symptoms abated after drug discontinuation and supportive treament. Clinicians must remain mindful of this rare complication of ustekinumab use in order to avoid potential delays in appropriate DAH treatment.
报告一例因乌司奴单抗治疗而发生弥漫性肺泡出血（DAH）的病例。
一位 46 岁女性因银屑病关节炎开始接受乌司奴单抗治疗后，出现流感样症状和咳嗽，咳带血痰，此前已持续 1 周。她最初的胸部计算机断层扫描显示双侧磨玻璃影。支气管镜检查显示，支气管肺泡灌洗液（BAL）从第 1 份标本到第 2 份和第 3 份标本的血液含量越来越多。她的 BAL 液中超过 90%是含铁血黄素的巨噬细胞，这一发现与 DAH 一致。我们排除了感染性病因和其他常见可导致 DAH 的血管炎疾病。由于药物开始使用和患者出现症状之间存在时间关系，且无感染和其他替代诊断，故诊断为乌司奴单抗诱导的 DAH。包括乌司奴单抗诱导的肺炎、具有肉芽肿成分的间质性肺疾病和狼疮综合征在内的先前病例报告已有报道，这是在接受银屑病关节炎治疗的患者中出现 DAH 的首例病例。
一名 46 岁女性在乌司奴单抗治疗期间发生 DAH。停药和支持治疗后症状缓解。临床医生必须意识到乌司奴单抗使用的这种罕见并发症，以避免对 DAH 治疗的潜在延误。
