J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 12, Number 7, July 2021, pages 295-299

Osimertinib-Induced Unilateral Diffuse Alveolar Hemorrhage in a Patient With Pulmonary Adenocarcinoma

Figures

Figure 1. Chest computed tomography on the diagnosis (a), 2 months after the start of osimertinib (b) and on admission (c).

Figure 2. Chest radiographs on 2 months after the initiation of osimertinib (a), on admission (b), and (c) at the time of extubation (on the hospital day 11).

Figure 3. The BALFs on the hospital day 1 (a) and 9 (b). BALF: bronchoalveolar lavage fluid.

Table

**Table 1.** Summary of Previous Cases of Alveolar Hemorrhage Induced by EGFR-TKI
Author (year)	EGFR-TKI (line)	Age (years), sex, country	Symptoms	Mutations	Interval^a	Steroid use (initial dose)	Respiratory management	BFS (differential cell count)
^aThe interval time from the start of EGFR-TKI to the onset of symptoms. EGFR-TKI: epidermal growth factor receptor tyrosine kinase inhibitor; Ex: exon; F: female; Gef: gefitinib; Lym: lymphocytes; M: male; mPSL: methylprednisolone; ND: not described; Neu: neutrophils; NPPV: non-invasive positive pressure ventilation; Osim: osimertinib; SQ: squamous carcinoma; BFS: bronchial fiberscope.
Ieki et al, 2003 [4]	Gef (4th)	56 M, Japan	Dyspnea, bloody phlegm	ND	4 weeks	High-dose mPSL	NPPV	Performed (90% Lym, 10% Neu)
Yano et al, 2005 [5]	Gef (4th)	62 F, Japan	ND	ND	13 months	mPSL (1,000 mg/day)	ND	ND
Zhao et al, 2014 [6]	Erl (1st)	40 M, China	Fever	Esophageal carcinoma (SQ)	1 month	mPSL (1,000 mg/day)	NPPV	Performed (ND)
Sakoda et al, 2011 [8]	Gef (2nd)	74 F, Japan	Epistaxis, bloody phlegm	ND	2 weeks	No steroid	Nasal O₂	Performed (ND)
Forte et al, 2019 [1]	Osim (multiple)	65 F, USA	Dyspnea, fatigue	Ex19del,T790M	5 months	mPSL (1,000 mg/day)	Intubated	Performed (ND)
Komori et al, 2019 [7]	Osim (2nd)	75 F, Japan	Bloody phlegm	L858R, T790M	2 months	PSL (0.5 mg/kg)	ND	Performed (20% Lym, 8% Neu)
Ours	Osim (1st)	70 M, Japan	Dyspnea	Ex19del	4 months	mPSL (1,000 mg/day)	Intubated	Performed (55% Lym, 44% Neu)