Diffuse alveolar hemorrhage after an ovum pick-up procedure induced by inhalational sevoflurane-A case report

초록

Introduction Diffuse alveolar hemorrhage (DAH) is a life-threatening syndrome which involves pulmonary microcirculation, causing hemoptysis and diffuse alveolar infiltration. DAH is mostly caused by systemic vasculitis and is rarely caused by drugs. Sevoflurane is a halogenated inhalational anesthetic widely used to induce and maintain general anesthesia. Like other halogenated anesthetics, exact mechanism of anesthesia by sevoflurane is unknown. To date, there are only 3 cases of DAH caused by sevoflurane. In this report, we report a first case of DAH caused by sevoflurane in Korea. Case Presentation A 40-year-old female visited emergency department with acute respiratory distress and hemoptys is after an ovum pick-up procedure using inhalational sevoflurane. The patient had no previous underlying disease and smoking history. This ovum pick-up procedure was her seventh; previous procedures were done only with propofol injection without sevoflurane and there was no event of acute respiratory distress or hemoptysis. Bronchoalveolar lavage result showed progressively more hemorrhagic BAL fluid with RBC count of 46000/μl. Infection and vasculitis were ruled out. The patient was treated with supportive care and intravenous methylprednisolone 1 mg/kg for 5 days. Hypoxemia and hemoptysis resolved without recurrence. Conclusion To date, there are only 3 cases reporting DAH caused by inhaled sevoflurane and mechanism of how sevoflurane causes DAH is unknown. This case highlights sevoflurane must be considered as differential diagnosis for DAH after excluding other possibilities.