Use of high-dose corticosteroids and high-frequency oscillatory ventilation for treatment of a child with diffuse alveolar hemorrhage after bone marrow transplantation: Case report and review of the literature

Background: Other than relapse, pulmonary complications are the most common cause of mortality in patients who undergo bone marrow transplantation (BM T). Diffuse alveolar hemorrhage (DAH) is one noninfectious pulmonary compli cation of BMT. Presenting clinical findings include nonproductive cough usu ally without hemoptysis, dyspnea, hypoxemia, a decrease in hematocrit, and diffuse infiltrates on chest radiograph. Patient We report a case of DAH after allogeneic BMT in a 6-yr-old female p atient. Although a chest radiograph revealed patchy bilateral alveolar dens ities and large volumes of bright red blood were suctioned from the endotra cheal tube, there was no evidence of coagulopathy and no infectious agent w as identified on examination of bronchoalveolar lavage fluid, blood, and ur ine. Intervention: The child was treated with high-dose corticosteroids and high -frequency oscillatory ventilation and experienced a complete clinical reco very from her pulmonary disease. Results: The definition, presenting symptoms, findings and timing, and asso ciated risk factors of DAH after BMT are reviewed, Prospective hypotheses f or the pathogenesis of DAH after BMT are presented. Evidence for the role o f high-dose corticosteroids for treatment of DAH after BMT and the role of high-frequency oscillatory ventilation for treatment of acute hypoxemic res piratory failure in children with diffuse alveolar disease is also reviewed . Conclusion: This case supports the contention that early treatment with hig h-dose corticosteroids is warranted in children with DAH after BMT.