Diffuse Alveolar Hemorrhage- A Case Report and Literature Review

Abstract

Diffuse alveolar hemorrhage (DAH) is a rare but fulminant syndrome. It is usually associated with systemic autoimmune diseases such as vasculitis, connective tissue disease, and anti-basement membrane antibody disease, and can accompany drug exposure or infection. Because of its non-specific clinical presentations, the diagnosis of DAH may be missed. Herein, we report a patient with DAH who initially presented with acute respiratory failure, hemosputum, and a bilateral alveolar radiographic pattern of chest infiltration. The patient was weaned off mechanical ventilation after bronchoscopic diagnosis of DAH and treatment with plasmapheresis and pulse therapy. Microscopic polyangiitis was confirmed by renal biopsy and a positive test using perinuclear antineutrophil cytoplasmic autoantibody. The present case highlights the importance of bronchoalveolar lavage and prompt initiation of steroid therapy following diagnosis.