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Case Reports
. 2025 Aug 10;17(8):e89713.
doi: 10.7759/cureus.89713. eCollection 2025 Aug.

Diffuse Alveolar Hemorrhage Leading to Respiratory Failure in Mixed Phenotype Acute Leukemia: A Fatal Pulmonary Complication

Mariela Ginés-Rosario  1 , Belissa Lopez-Pena  1 , Zydnia Piñeiro  1 , Maria C Perez-Mitchell  2 , Ricardo Fernandez-Gonzalez  2
Affiliations
Case Reports

Diffuse Alveolar Hemorrhage Leading to Respiratory Failure in Mixed Phenotype Acute Leukemia: A Fatal Pulmonary Complication

Mariela Ginés-Rosario et al. Cureus. .

Abstract

Mixed phenotype acute leukemia (MPAL) is a rare and diagnostically challenging hematologic malignancy characterized by the co-expression of myeloid and lymphoid lineage markers. We present the case of a 61-year-old woman with newly diagnosed MPAL who developed diffuse alveolar hemorrhage (DAH) shortly after induction chemotherapy. Despite aggressive supportive care, including bronchoscopy-guided diagnosis, high-dose corticosteroids, antifibrinolytics, and lung-protective ventilation with prone positioning, her condition rapidly deteriorated into multi-organ failure and death. This case highlights the need for early recognition of pulmonary complications in high-risk leukemias and underscores the limitations of current management strategies in the setting of DAH complicating MPAL.

Keywords: blood malignancy; diffusse alveolar hemorrhage; leukemia; mixed-phenotype acute leukemia; pulmonary complications.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Coronal chest CT in lung window demonstrating diffuse, bilateral ground-glass opacities with patchy areas of consolidation throughout both lungs. Given the bronchoscopy findings of DAH, the CT findings represent bloody alveolar infiltrates.
Red arrows indicating areas of ground-glass opacities. CT: Computed tomography, DAH: Diffuse alveolar hemorrhage
Figure 2
Figure 2. Axial chest CT in lung window demonstrating bilateral, diffuse ground-glass opacities with interspersed areas of consolidation, predominantly in the central and dependent lung regions. The pattern is symmetric and involves both upper and lower lobes. These findings are consistent with diffuse alveolar hemorrhage.
Red arrows indicating widespread ground-glass opacities in both lungs, accompanied by scattered regions of consolidation.
Figure 3
Figure 3. Hypercellular bone marrow histopathology.
Red circles: areas showing dense infiltration of immature blasts and high mitotic/proliferative activity.
See this image and copyright information in PMC

References

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