Localized Leukemic Pulmonary Infiltrates

Pulmonary complications which occur in as many as 80 percent of patients with acute leukemia, are i leading cause of morbidity and mortality. Because :he etiology is rarely apparent from the clinical pres­entation, physicians must often choose between a x)urse of empiric therapy or an invasive diagnostic Drocedure to obtain a specific diagnosis. Advocates of m attempt at early diagnosis emphasize the broad ;pectrum of disorders that can cause pulmonary complications in patients with leukemia, while pro- Donents of empiric treatment point to the substantial isk associated with invasive diagnostic procedures in nany of these individuals.

Several authors have suggested that the choice between empiric therapy and early use of an invasive liagnostic technique should be based in part on the •oentgenographic pattern of the pulmonary infil- rates. These authors reported that, in their experi­ence, focal pulmonary infiltrates were usually caused bу ordinary bacterial infections while diffuse pulmo- lary infiltrates were commonly caused by opportun- stic organisms or by a variety of noninfectious disor- lers such as hemorrhage, pulmonary edema, or eukemic infiltrates. Accordingly, many clinicians have idopted a roentgenographically guided approach to he initial management of this problem. Empiric intibiotic therapy is used for most patients with local pulmonary infiltrates, and early bronchoscopy or open ung biopsy is preferred for most patients with diffuse Dulmonary infiltrates. levitra plus

Recently, we encountered three patients with acute leukemia who developed cough, dyspnea, fever, and localized pulmonary infiltrates that were caused by leukemic invasion of the lung. In each case, the diagnosis of pulmonary leukemic infiltrates was estab­lished by histologic examination of transbronchial biopsy specimens and confirmed by complete resolu­tion following chemotherapy. These cases demonstrate that pulmonary leukemic infiltrates can mimic acute focal bacterial pneumonia and that early use of fiber­optic bronchoscopy can favorably influence the treat­ment of certain patients who develop focal pulmonary infiltrates as a complication of acute leukemia.