Published ahead of print on February 5, 2003, doi:10.1164/rccm.200206-554OC Am. J. Respir. Crit. Care Med., Volume 167, Number 10, May 2003, 1329-1333 A more recent version of this article appeared on May 15, 2003
Submitted on June 13, 2002 Acute Monocytic Leukemia Presenting as Acute Respiratory FailureELIE AZOULAY1*,1 Medical ICU, Saint-Louis Hospital Service de Reanimation Medicale, Paris, France, 2 Hematology, Saint-Louis Teaching Hospital and Paris 7 University, Paris, France, 3 Respiratory and Critical Care Department, Tenon Hospital and Hopitaux de Paris, Paris, France * To whom correspondence should be addressed. E-mail: elie.azoulay{at}sis.ap-hop-paris.fr.
Acute respiratory failure revealing acute monocytic leukemia is rare. We report 20 patients admitted to the ICU with three remarkable features: 1) rapidly progressive respiratory distress revealing acute leukemia, 2) monocytic leukemia, and 3) respiratory status deterioration after chemotherapy initiation. Median age was 50 years (17-72) and respiratory symptoms started 2 (0-15) days before ICU admission. Median leukocyte count was 98 250/mm3 (800-529 000), with circulating monocytic cells in all but one patient. Bone marrow was diagnostic of monocytic leukemia in all patients. At presentation, respiratory rate was 33 (18-50) per minute and PaO2 on room air was 44.5 mmHg (30-60). Chest radiographs revealed unilateral alveolar infiltrates (n=1), bilateral alveolar infiltrates with (n=3) or without (n=11) pleural effusion, or diffuse interstitial infiltrates (n=5). Alveolar hemorrhage was the main bronchoalveolar lavage finding, with monocytic cells retrieved in four patients. Respiratory function deteriorated following cancer chemotherapy initiation in all patients. Of the 15 patients who required mechanical ventilation, 10 died. Leukemic pulmonary infiltration as the first manifestation of acute monocytic leukemia should be recognized, and intensive management should be provided in anticipation of the respiratory function deterioration seen consistently after chemotherapy initiation. Key words: acute respiratory failure; acute monocytic leukemia; BAL fluid analysis; intensive care unit; alveolar hemorrhage.
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