array:23 [
  "pii" => "S0300289623001126"
  "issn" => "03002896"
  "doi" => "10.1016/j.arbres.2023.03.013"
  "estado" => "S300"
  "fechaPublicacion" => "2023-06-01"
  "aid" => "3293"
  "copyright" => "The Author(s)"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2023;59:396"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0300289623000078"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2023.01.002"
    "estado" => "S300"
    "fechaPublicacion" => "2023-06-01"
    "aid" => "3244"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2023;59:397-400"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Prevalence and Risk Factors for Airflow Limitation in Patients With Acute Coronary Syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "397"
          "paginaFinal" => "400"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Santiago Rodriguez-Segade Alonso, Carmen Diego Roza, Raquel Marzoa Rivas, Irene Nieto Codesido, Elvira Clavero Fern&#225;ndez, F&#233;lix Cami&#241;a"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Rodriguez-Segade Alonso"
            ]
            1 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Diego Roza"
            ]
            2 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Marzoa Rivas"
            ]
            3 => array:2 [
              "nombre" => "Irene"
              "apellidos" => "Nieto Codesido"
            ]
            4 => array:2 [
              "nombre" => "Elvira Clavero"
              "apellidos" => "Fern&#225;ndez"
            ]
            5 => array:2 [
              "nombre" => "F&#233;lix"
              "apellidos" => "Cami&#241;a"
            ]
            6 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Rodriguez-Segade"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623000078?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623000078/v2_202308080837/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0300289623001060"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2023.03.007"
    "estado" => "S300"
    "fechaPublicacion" => "2023-06-01"
    "aid" => "3287"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2023;59:394-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
      "titulo" => "Acute Hemorrhage into an Emphysematous Bulla"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "394"
          "paginaFinal" => "395"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1149
              "Ancho" => 982
              "Tamanyo" => 132719
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiplanar chest CT reconstructions with intravenous contrast in axial &#40;A&#41; and sagittal &#40;B&#41; planes where a bulla located in the medial basal segment of the LLL with hematic level is observed&#46; 3D segmentation of the findings in axial &#40;C&#41; and sagittal &#40;D&#41; projection&#46; In orange &#40;C and D&#41;&#44; the airway and bulla stand out&#44; and bleeding is shown in red&#46; Multiplanar CT reconstructions without intravenous contrast in axial &#40;E&#41; and sagittal &#40;F&#41; planes 5 months later&#46; Persistence of the bulla located in the medial basal segment of LLL with smaller size and in the absence of the hematic level &#40;E and F&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Jes&#250;s Lobo-Rebollo, Carlota Garc&#237;a-Bar&#243;n, Felipe Villar-&#193;lvarez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Mar&#237;a Jes&#250;s"
              "apellidos" => "Lobo-Rebollo"
            ]
            1 => array:2 [
              "nombre" => "Carlota"
              "apellidos" => "Garc&#237;a-Bar&#243;n"
            ]
            2 => array:2 [
              "nombre" => "Felipe"
              "apellidos" => "Villar-&#193;lvarez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001060?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623001060/v2_202308080837/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
    "titulo" => "Alectinib-Induced Diffuse Alveolar Hemorrhage"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "396"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Yosuke Fukuda, Hironori Sagara"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Yosuke"
            "apellidos" => "Fukuda"
            "email" => array:1 [
              0 => "y.f.0423@med.show-au.ac.jp"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Hironori"
            "apellidos" => "Sagara"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Medicine&#44; Division of Respiratory Medicine and Allergology&#44; Showa University Koto Toyosu Hospital&#44; Tokyo&#44; Japan"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Medicine&#44; Division of Respiratory Medicine and Allergology&#44; Showa University School of Medicine&#44; Tokyo&#44; Japan"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1071
            "Ancho" => 2167
            "Tamanyo" => 443164
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography shows bilateral scattered ground-glass opacities with thickening of the interlobular septa &#40;A&#8211;C&#44; white arrows&#41;&#46; Bloody bronchoalveolar lavage fluid &#40;D&#41;&#59; cytology shows hemosiderin-laden macrophages &#40;E&#41;&#46; Chest computed tomography shows an irregular mass in the left central lung &#40;F&#44; asterisk&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old non-smoker man presented to the outpatient clinic with a chief complaint of dysgraphia&#46; Magnetic resonance imaging of the brain revealed a 62-mm mass in the left occipital lobe&#44; and brain biopsy revealed metastatic lung cancer harboring a rearrangement in the anaplastic lymphoma kinase &#40;ALK&#41; gene&#46; Five days after initiating first-line chemotherapy with alectinib&#44; the patient complained of a dry cough&#46; Chest computed tomography showed bilateral scattered ground-glass opacities with thickening of the interlobular septa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;C&#41;&#46; Bronchoalveolar lavage of the right upper lobe retrieved a bloody fluid with a gradual increase in concentration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#44; and cytology revealed hemosiderin-laden macrophages &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; We diagnosed the patient with alectinib-induced diffuse alveolar hemorrhage &#40;DAH&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The patient&#39;s condition rapidly improved after discontinuation of alectinib and initiation of systemic steroid therapy&#46; Lorlatinib was safely administered as the second-line chemotherapy without DAH&#46; ALK-inhibitor induced DAH has not been previously reported&#46; In this case&#44; age was the only risk factor for interstitial lung disease associated with ALK inhibitors&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> In central lung cancer&#44; promptly performing a bronchoscopy aids the treatment strategy because airway obstruction due to bleeding can be critical &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; The patient provided informed consent for the publication this article&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Funding"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Conflict of interest"
        ]
        2 => array:2 [
          "identificador" => "xack682138"
          "titulo" => "Acknowledgments"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1071
            "Ancho" => 2167
            "Tamanyo" => 443164
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography shows bilateral scattered ground-glass opacities with thickening of the interlobular septa &#40;A&#8211;C&#44; white arrows&#41;&#46; Bloody bronchoalveolar lavage fluid &#40;D&#41;&#59; cytology shows hemosiderin-laden macrophages &#40;E&#41;&#46; Chest computed tomography shows an irregular mass in the left central lung &#40;F&#44; asterisk&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:2 [
            0 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary capillaritis and alveolar hemorrhage&#46; Update on diagnosis and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Green"
                            1 => "S&#46;J&#46; Ruoss"
                            2 => "S&#46;A&#46; Kraft"
                            3 => "S&#46;R&#46; Duncan"
                            4 => "G&#46;J&#46; Berry"
                            5 => "T&#46;A&#46; Raffin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.110.5.1305"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "110"
                        "paginaInicial" => "1305"
                        "paginaFinal" => "1316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8915239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anaplastic lymphoma kinase inhibitor related pneumonitis in patients with non-small cell lung cancer&#58; clinical and radiologic characteristics and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;J&#46; Hwang"
                            1 => "M&#46;Y&#46; Kim"
                            2 => "C&#46;M&#46; Choi"
                            3 => "J&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MD.0000000000018131"
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2019"
                        "volumen" => "98"
                        "paginaInicial" => "e18131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31770246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack682138"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">We would like to thank Editage &#40;<a target="_blank" href="http://www.editage.jp/">www&#46;editage&#46;jp</a>&#41; for English language editing&#46; In addition&#44; we would like to thank the staff of the department of pathology at Showa University Koto Toyosu Hospital&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623001126/v2_202308080837/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "94561"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Clinical Images"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005900000006/v2_202308080837/S0300289623001126/v2_202308080837/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001126?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 59. Issue 6.
Pages 396 (June 2023)
Share
Share
Download PDF
More article options
Visits
1917
Vol. 59. Issue 6.
Pages 396 (June 2023)
Clinical Image
Full text access
Alectinib-Induced Diffuse Alveolar Hemorrhage
Visits
1917
Yosuke Fukudaa,
Corresponding author
y.f.0423@med.show-au.ac.jp

Corresponding author.
, Hironori Sagarab
a Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University Koto Toyosu Hospital, Tokyo, Japan
b Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

A 56-year-old non-smoker man presented to the outpatient clinic with a chief complaint of dysgraphia. Magnetic resonance imaging of the brain revealed a 62-mm mass in the left occipital lobe, and brain biopsy revealed metastatic lung cancer harboring a rearrangement in the anaplastic lymphoma kinase (ALK) gene. Five days after initiating first-line chemotherapy with alectinib, the patient complained of a dry cough. Chest computed tomography showed bilateral scattered ground-glass opacities with thickening of the interlobular septa (Fig. 1A–C). Bronchoalveolar lavage of the right upper lobe retrieved a bloody fluid with a gradual increase in concentration (Fig. 1D), and cytology revealed hemosiderin-laden macrophages (Fig. 1E). We diagnosed the patient with alectinib-induced diffuse alveolar hemorrhage (DAH).1 The patient's condition rapidly improved after discontinuation of alectinib and initiation of systemic steroid therapy. Lorlatinib was safely administered as the second-line chemotherapy without DAH. ALK-inhibitor induced DAH has not been previously reported. In this case, age was the only risk factor for interstitial lung disease associated with ALK inhibitors.2 In central lung cancer, promptly performing a bronchoscopy aids the treatment strategy because airway obstruction due to bleeding can be critical (Fig. 1F). The patient provided informed consent for the publication this article.

Fig. 1.

Chest computed tomography shows bilateral scattered ground-glass opacities with thickening of the interlobular septa (A–C, white arrows). Bloody bronchoalveolar lavage fluid (D); cytology shows hemosiderin-laden macrophages (E). Chest computed tomography shows an irregular mass in the left central lung (F, asterisk).

(0.42MB).
Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

None.

Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing. In addition, we would like to thank the staff of the department of pathology at Showa University Koto Toyosu Hospital.

References
[1]
R.J. Green, S.J. Ruoss, S.A. Kraft, S.R. Duncan, G.J. Berry, T.A. Raffin.
Pulmonary capillaritis and alveolar hemorrhage. Update on diagnosis and management.
Chest, 110 (1996), pp. 1305-1316
[2]
H.J. Hwang, M.Y. Kim, C.M. Choi, J.C. Lee.
Anaplastic lymphoma kinase inhibitor related pneumonitis in patients with non-small cell lung cancer: clinical and radiologic characteristics and risk factors.
Medicine (Baltimore), 98 (2019), pp. e18131
Copyright © 2023. The Author(s)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?