A Case of Thrombocytopenia Induced by Hypersplenism for Severe Right Heart Failure and Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage at the Initial Visit in a Patient with Pulmonary Veno-occlusive Disease

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  • Takatsuka Makiko
    Department of Respiratory Medicine, Saitama Red Cross Hospital Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine
  • Yamakawa Hideaki
    Department of Respiratory Medicine, Saitama Red Cross Hospital Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine
  • Ohta Hiroki
    Department of Respiratory Medicine, Saitama Red Cross Hospital
  • Akasaka Keiichi
    Department of Respiratory Medicine, Saitama Red Cross Hospital
  • Amano Masako
    Department of Respiratory Medicine, Saitama Red Cross Hospital
  • Matsushima Hidekazu
    Department of Respiratory Medicine, Saitama Red Cross Hospital

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  • 初診時より脾機能亢進による著明な血小板減少と呼吸不全を呈し，気管支肺胞洗浄で肺胞出血を確認した肺静脈閉塞症の1例

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Abstract

<p>Background. Pulmonary veno-occlusive disease (PVOD) is a disease in which pulmonary vascular resistance increases due to stenosis/occlusion of the pulmonary veins, resulting in pulmonary hypertension. We herein report a case of respiratory failure due to alveolar hemorrhage and thrombocytopenia due to hypersplenism induced by right heart failure. Case. An 18-year-old man was admitted to the hospital for a fever and type I respiratory failure. Laboratory data showed thrombocytopenia (platelet count: 22,000/μl) and chest computed tomography (CT) showed ground-glass opacities predominantly in the bilateral lower lobe, bilateral pleural effusion, and thickening of the interlobular septum. A cardiac catheter test revealed pulmonary hypertension, and bronchoscopy revealed alveolar hemorrhage. In addition, a pulmonary function test showed a decreased diffusion capacity. Based on these findings, the patient was diagnosed with PVOD. Although non-invasive positive pressure ventilation therapy was temporarily required, the respiratory condition, pulmonary opacities, and thrombocytopenia gradually improved with body fluid management and supplemental oxygen therapy. The patient was discharged from the hospital after the introduction of home oxygen therapy. Conclusions. PVOD may induce subclinical alveolar hemorrhage, and bronchoscopy proved useful for an early diagnosis in the present patient. Furthermore, hypersplenism due to severe right heart failure might have caused thrombocytopenia in this case.</p>

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