Diffuse Alveolar Hemorrhage Associated with Makyo-kanseki-to Administration

Abstract

We herein describe the first known case of diffuse alveolar hemorrhage (DAH) associated with the administration of Makyo-kanseki-to, a Chinese herbal drug. A 64-year-old man with bronchial asthma presented with persistent cough. Makyo-kanseki-to was prescribed as an adjunctive treatment for bronchial asthma. Immediately after drug ingestion, the patient expectorated bloody sputum. DAH was diagnosed based on the presence of bilateral ground-glass opacity which was identified on chest computed tomography and bloody bronchoalveolar lavage fluid. We diagnosed that the administration of Makyo-kanseki-to was the responsible medication because the hemorrhage developed immediately after drug ingestion and resolved after the cessation of such medication with no subsequent recurrence.

Figure 1.

Chest computed tomography on admission (A) showed the presence of bilateral ground-glass opacity in the upper lung, which disappeared by day 12 (B).

Figure 2.

The direct appearance of bronchoalveolar lavage fluid (A). Hematoid color increased on every lavage (total of 3). Bronchoalveolar lavage fluid (B) showed 38.5% of hemosiderin-laden macrophages for iron staining.