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Pulmonary Capillary Hemangiomatosis With Atypical Endotheliomatosis^*

Successful Antiangiogenic Therapy With Doxycycline

^* From the Pulmonary and Critical Care Unit (Drs. Ginns and Roberts), General Medical Services, and the Department of Pathology (Dr. Mark), Massachusetts General Hospital, Boston, MA; the Department of Surgical Research (Dr. Marler), Children’s Hospital Medical Center, Boston, MA; and the Department of Medicine (Dr. Brusch), Cambridge Hospital and Harvard Medical School, Boston, MA.

Correspondence to: Leo C. Ginns, MD, FCCP, Pulmonary and Critical Care Unit, White 907, Massachusetts General Hospital, Boston, MA 02114; e-mail: lginns{at}partners.org

We report here our experience in achieving remission in a 20-year-old man with pulmonary capillary hemangiomatosis (PCH) with atypical endotheliomatosis following therapy with doxycycline. PCH is a rare disorder characterized by proliferating capillaries that invade the pulmonary interstitium and alveolar septae, and occlude the pulmonary vasculature. The patient’s symptoms, lung function, and radiographic findings had worsened despite treatment with both prednisone and -interferon. He was considered to be a candidate for transplantation. Given the elevated levels of basic fibroblast growth factor (bFGF) in urine and the capillary proliferation noted on biopsy specimens, we elected to treat the patient with doxycycline, a matrix metalloproteinase and angiogenesis inhibitor. Following several weeks of therapy, a gradual resolution of symptoms was noted, with normalization of pulmonary function test results and urine bFGF levels. After 18 months of therapy, the patient remains in complete remission.

Key Words: -interferon • angiogenesis • antiangiogenic therapy • basic fibroblast growth factor • matrix metalloproteinases • pulmonary capillary hemangiomatosis

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