Abstract
Diffuse alveolar hemorrhage (DAH) secondary to anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is rare in clinical practice and may present as severe acute respiratory distress syndrome (ARDS) with high mortality. Extracorporeal membrane oxygenation (ECMO) has been reported to be a salvage treatment providing the time necessary for immunosuppressive treatment in cases accompanied by severe ARDS. Prone positioning (PP) has been proven to reduce the mortality in patients with severe ARDS. However, there is no consensus about choosing PP or ECMO in severe ARDS due to DAH secondary to ANCA-associated vasculitis. We reported a case of microscopic polyangiitis (MPA)-related DAH and severe ARDS treated with PP successfully providing the time necessary for early glucocorticoids and plasma exchange to control the underlying disease. Since anticoagulation therapy is not necessary in PP, it does not increase the risk of bleeding tendency unlike ECMO. PP has a life-saving role in the management of patients with severe ARDS due to ANCA-associated pulmonary vasculitis.
Highlights
acute respiratory distress syndrome (ARDS), a life-threatening condition, causes severe mortality that varies from 34.9% for mild ARDS to 46.1% for severe ARDS, even with mechanical ventilation or even Extracorporeal membrane oxygenation (ECMO) support [1]
ARDS, a life-threatening condition, causes severe mortality that varies from 34.9% for mild ARDS to 46.1% for severe ARDS, even with mechanical ventilation or even ECMO support [1]
We report a case of a 74-year-old male who was diagnosed with Diffuse alveolar hemorrhage (DAH)-related ARDS treated successfully with prone positioning
Summary
ARDS, a life-threatening condition, causes severe mortality that varies from 34.9% for mild ARDS to 46.1% for severe ARDS, even with mechanical ventilation or even ECMO support [1]. DAH, a rare cause of ARDS, presents with hemoptysis resulting from intra-alveolar. RBC accumulation and may hinder alveolar oxygenation and progress to hypoxia [2]. We report a case of a 74-year-old male who was diagnosed with DAH-related ARDS treated successfully with prone positioning. Serology tests proved it to be ANCA-associated vasculitis [3]. We reviewed the related literature and proposed the preferable choice of prone positioning or ECMO under such circumstances
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