Letter to the Editor
Occult Alveolar Hemorrhage in a Patient With Bronchopulmonary Kaposi Sarcoma
Hemorragia alveolar oculta en paciente con sarcoma de Kaposi broncopulmonar
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He presented due to the appearance of violaceous skin lesions on the face, dyspnea and pleuritic pain with a CD4 T-lymphocyte count of 149<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> and viral load of 52<span class="elsevierStyleHsp" style=""></span>092<span class="elsevierStyleHsp" style=""></span>copies/ml. High resolution computed tomography of the chest (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed bilateral nodules with irregular margins and ground glass opacities, peribronchial cuffing and left pleural effusion. Bronchoscopy showed a raised lesion in the mucous membrane of the apical segment of the right upper lobe. Abundant hemosiderophages were found in the bronchoalveolar lavage (BAL) fluid, confirming alveolar hemorrhage. Immunohistochemistry was positive for human herpesvirus 8 (HHV-8). Treatment began with liposomal doxorubicin and antiretroviral treatment was switched. The patient remains alive at 8 months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Kaposi sarcoma involving the lung occurs in 6%–32% of patients with acquired immunodeficiency syndrome (AIDS). It presents with skin lesions,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> and in 47%–75% of patients it is diagnosed <span class="elsevierStyleItalic">post-mortem</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Lesions can appear in the pulmonary parenchyma, bronchial tree, pleura, chest wall, and mediastinal lymph nodes,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> and CD4 T-lymphocyte count is generally <100<span class="elsevierStyleHsp" style=""></span>cells/mm.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In 80% of cases, death is a result of co-infection, due to cytomegalovirus, <span class="elsevierStyleItalic">Mycobacterium avium</span> complex, <span class="elsevierStyleItalic">Pneumocistis jirovecii</span>, bacterial pneumonia and herpes simplex infection.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Chest computed tomography reveals poorly defined bilateral nodules, distributed symmetrically around the bronchial vessels (flame-like lesions). Other findings include septal peribronchial and interlobar cuffing, progressive air space consolidation and ground glass opacities.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Lesions on the palate are a strong predictor for bronchopulmonary involvement.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Typical lesions observed on bronchoscopy are red or violaceous cherry-like plaques in the bronchial Tree.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> HHV-8 is detected in BAL, which is highly specific (95%–98.9%) with variable sensitivity (58%–100%).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Occult alveolar hemorrhage has been described in HIV-positive patients with respiratory symptoms and abnormal radiological findings in the absence of hemoptysis. In 35.6% of cases, bronchopulmonary Kaposi sarcoma was detected, and of these 60.5% had occult alveolar hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Vincent et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> subsequently characterized the following risk factors for AIDS-related alveolar hemorrhage: Kaposi sarcoma (OR: 5.3; 95% CI: 1.8–16.7; <span class="elsevierStyleItalic">P</span>=.003); cytomegalovirus pneumonia (OR: 9.8; 95% CI: 1–100; <span class="elsevierStyleItalic">P</span>=.05); hydrostatic pulmonary edema (OR: 16.4; 95% CI: 1.8–142; <span class="elsevierStyleItalic">P</span>=.01) and platelet count <60<span class="elsevierStyleHsp" style=""></span>000 (OR: 5.6; 95% CI: 1.5–20; <span class="elsevierStyleItalic">P</span>=.009).</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, bronchoscopy is a useful tool for the diagnosis of occult alveolar hemorrhage in patients with HIV infection and respiratory symptoms.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This report received no type of funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martinez Ramirez I, Luquez AJ, Garcia Herreros P. Hemorragia alveolar oculta en paciente con sarcoma de Kaposi broncopulmonar. Arch Bronconeumol. 2015;51:364–365.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 545 "Ancho" => 1000 "Tamanyo" => 79613 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography of the chest showing bilateral nodules with irregular margins, ground glass opacities and peribronchial cuffing.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HIV/AIDS: epidemiology, pathophysiology, and treatment of Kaposi sarcoma-associated herpes virus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. 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Lundgren" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "1997" "volumen" => "29" "numero" => "Suppl. 1" "paginaInicial" => "S13" "paginaFinal" => "S16" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult alveolar haemorrhage in bronchopulmonary Kaposi’ sarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Hughes-Davies" 1 => "G. Kocjan" 2 => "M.F. Spittle" 3 => "R.F. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "1992" "volumen" => "45" "numero" => "Suppl. 6" "paginaInicial" => "S536" "paginaFinal" => "S537" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AIDS-related alveolar hemorrhage: a prospective study of 273 BAL procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Vincent" 1 => "A. Flahault" 2 => "M. Antoine" 3 => "M. Wislez" 4 => "A. Parrot" 5 => "C. Mayaud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2001" "volumen" => "120" "numero" => "Suppl. 4" "paginaInicial" => "S1078" "paginaFinal" => "S1084" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Our thanks go to Drs Edgar Sánchez and Alfredo Saavedra, Internists and Pulmonologists from the Pulmonology Unit, Instituto Nacional de Cancerología, Universidad Nacional de Colombia.</p> <p id="par0050" class="elsevierStylePara elsevierViewall">We also thank Dr Sonia Cuervo, Infectologist from the Instituto Nacional de Cancerología, Bogotá, Colombia.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000007/v1_201506250123/S1579212915001160/v1_201506250123/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000007/v1_201506250123/S1579212915001160/v1_201506250123/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001160?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 41 | 21 | 62 |
| 2024 September | 44 | 13 | 57 |
| 2024 August | 76 | 44 | 120 |
| 2024 July | 48 | 21 | 69 |
| 2024 June | 63 | 31 | 94 |
| 2024 May | 74 | 31 | 105 |
| 2024 April | 47 | 28 | 75 |
| 2024 March | 47 | 20 | 67 |
| 2024 February | 37 | 18 | 55 |
| 2024 January | 1 | 0 | 1 |
| 2023 March | 10 | 7 | 17 |
| 2023 February | 42 | 27 | 69 |
| 2023 January | 48 | 51 | 99 |
| 2022 December | 56 | 50 | 106 |
| 2022 November | 55 | 31 | 86 |
| 2022 October | 62 | 36 | 98 |
| 2022 September | 40 | 25 | 65 |
| 2022 August | 49 | 45 | 94 |
| 2022 July | 61 | 43 | 104 |
| 2022 June | 49 | 31 | 80 |
| 2022 May | 60 | 41 | 101 |
| 2022 April | 37 | 31 | 68 |
| 2022 March | 58 | 56 | 114 |
| 2022 February | 44 | 34 | 78 |
| 2022 January | 52 | 63 | 115 |
| 2021 December | 60 | 46 | 106 |
| 2021 November | 47 | 47 | 94 |
| 2021 October | 49 | 37 | 86 |
| 2021 September | 39 | 45 | 84 |
| 2021 August | 37 | 27 | 64 |
| 2021 July | 62 | 26 | 88 |
| 2021 June | 55 | 45 | 100 |
| 2021 May | 41 | 23 | 64 |
| 2021 April | 106 | 50 | 156 |
| 2021 March | 64 | 28 | 92 |
| 2021 February | 24 | 10 | 34 |
| 2021 January | 23 | 13 | 36 |
| 2020 December | 34 | 20 | 54 |
| 2020 November | 23 | 10 | 33 |
| 2020 October | 25 | 12 | 37 |
| 2020 September | 28 | 11 | 39 |
| 2020 August | 43 | 20 | 63 |
| 2020 July | 30 | 23 | 53 |
| 2020 June | 30 | 7 | 37 |
| 2020 May | 39 | 17 | 56 |
| 2020 April | 34 | 24 | 58 |
| 2020 March | 25 | 12 | 37 |
| 2020 February | 41 | 16 | 57 |
| 2020 January | 52 | 19 | 71 |
| 2019 December | 56 | 25 | 81 |
| 2019 November | 42 | 22 | 64 |
| 2019 October | 30 | 11 | 41 |
| 2019 September | 30 | 20 | 50 |
| 2019 August | 26 | 19 | 45 |
| 2019 July | 31 | 17 | 48 |
| 2019 June | 25 | 9 | 34 |
| 2019 May | 28 | 19 | 47 |
| 2019 April | 51 | 33 | 84 |
| 2019 March | 35 | 23 | 58 |
| 2019 February | 37 | 14 | 51 |
| 2019 January | 33 | 14 | 47 |
| 2018 December | 39 | 14 | 53 |
| 2018 November | 51 | 24 | 75 |
| 2018 October | 72 | 21 | 93 |
| 2018 September | 26 | 12 | 38 |
| 2018 May | 18 | 2 | 20 |
| 2018 April | 27 | 4 | 31 |
| 2018 March | 120 | 4 | 124 |
| 2018 February | 301 | 3 | 304 |
| 2018 January | 17 | 6 | 23 |
| 2017 December | 27 | 4 | 31 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 23 | 7 | 30 |
| 2017 September | 22 | 3 | 25 |
| 2017 August | 23 | 6 | 29 |
| 2017 July | 15 | 13 | 28 |
| 2017 June | 36 | 15 | 51 |
| 2017 May | 26 | 9 | 35 |
| 2017 April | 22 | 7 | 29 |
| 2017 March | 14 | 2 | 16 |
| 2017 February | 16 | 8 | 24 |
| 2017 January | 20 | 7 | 27 |
| 2016 December | 25 | 7 | 32 |
| 2016 November | 40 | 8 | 48 |
| 2016 October | 37 | 11 | 48 |
| 2016 September | 34 | 14 | 48 |
| 2016 August | 51 | 17 | 68 |
| 2016 July | 21 | 6 | 27 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 November | 1 | 9 | 10 |
| 2015 October | 46 | 3 | 49 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 0 | 1 | 1 |
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