ANOTHER BLOODY PNEUMONIA? DIFFUSE ALVEOLAR HEMORRHAGE RESULTING FROM IDIOPATHIC THROMBOCYTOPENIC PURPURA

Abstract

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Diffuse alveolar haemorrhage (DAH) is a rare life-threatening pulmonary bleeding manifestation of Idiopathic thrombocytopenic purpura (ITP). CASE PRESENTATION: A 74-year-old gentleman presented to the emergency triage with haemoptysis, worsening shortness of breath, and desaturation. X-ray and CT chest revealed opacifications suggestive of pulmonary haemorrhage. Platelet count was found to be 5,000/μL. Further history revealed he was recently weaned off his usual steroid dose for ongoing ITP. He was initiated on CPAP and received 1 platelet pool. Prednisolone dose was escalated to 1mg/kg once-daily with a stat dose of IVIG(1g/kg). His breathing improved with elevation of platelet count to 37,000/μL. Unfortunately, developed hypoxic respiratory failure again within next couple of days as his platelet count dropped down to 7,000/μL. He was started on eltrombopag along with a repeat platelet transfusion and another dose of IVIG(1g/kg). Clinico-radiological improvement was noted. Platelet count returned to normal by week 6 after admission. DISCUSSION: There is a poor correlation between the degree of thrombocytopenia and bleeding; however, platelet count <10,000/μL is associated with serious bleeding. Histopathologic findings in DAH vary from pulmonary capillaritis, bland hemorrhage to eventual development of diffuse alveolar damage, and hemosiderin-laden macrophages. Immunosuppressive agents are the mainstay of treatment. CONCLUSIONS: We reiterate to keep in mind the possible association between ITP and DAH in the appropriate clinical context. Reference 1: Ioachimescu, O.C. Diffuse alveolar hemorrhage: Diagnosing it and finding the cause. Clevel. Clin. J. Med. 2008 Reference 2: Newsome, B.R.; Morales, J.E. Diffuse alveolar hemorrhage. South. Med. J. 2011, 104, 269–274 DISCLOSURE: Nothing to declare. KEYWORD: diffuse alveolar haemorrhage, idiopathic thrombocytopenic purpura