The fundamental process common to each of the dah syndromes is diffuse bleeding into the acinar portion of the lung. The differential diagnosis included pulmonaryrenal syndrome prs was considered. Diffuse alveolar hemorrhage as the presenting feature of. Among the various underlying disorders, vasculitis is believed to play a significant role in the pathogenesis of dah. Diffuse alveolar hemorrhage dah is a rare but devastating manifestation of antiphospholipid syndrome aps patients with or without other systemic autoimmune diseases. Jun 14, 2017 diffuse alveolar haemorrhage due to rheumatoid arthritis is a rare phenomenon that has a high rate of recurrence. Diffuse alveolar hemorrhage with underlying isolated. Diffuse alveolar hemorrhage pulmonary disorders msd. Biological therapies like rituximab have demonstrated benefit mainly in. Cureus cannabis smokinginduced diffuse alveolar hemorrhage.
Diffuse alveolar hemorrhage is bleeding from many alveoli throughout the lungs. Blood tends to fill alveolar spaces at multiple sites. It can occur in a vast number of clinical situations and can be lifethreatening. Laboratory findings showed elevated serum creatinine with proteinuria and haematuria. A 78yearold man presented with acuteonset fever and dyspnea. We here report the case of an 81yearold male subject affected by a multifactorial dah, in which the bleeding was related to the administration of clopidogrel and. Diffuse alveolar hemorrhage dah frequently is a lifethreatening feature of pulmonaryrenal syndromes.
Diffuse alveolar hemorrhage dah is a rare disease characterized by dyspnea, cough, hemoptysis, and new alveolar infiltrates. Successful rituximab therapy in a lupus patient with diffuse. An early accumulative dose of 6 g was sufficient to cause interstitial disease, but hemoptysis with severe anemia and respiratory failure arose at 24 g. Anca in the serum and the results of bronchoalveolar lavage fluid. Diffuse alveolar hemorrhage is a rare feature of iga vasculitis, with only a small number of cases reported to date. Current management strategies are limited to corticosteroids, platelet transfusions, and mechanical ventilator support to treat acute respiratory failure. A chest imaging revealed bilateral consolidation predominantly in upper lungs. Pdf exhaled no in diffuse alveolar haemorrhage enrico. Diffuse alveolar hemorrhage is a lifethreatening complication after bone marrow transplantation. Diffuse alveolar hemorrhage radiology reference article. Some disorders that cause diffuse alveolar hemorrhage are associated with glomerulonephritis.
Early bronchoscopy with bronchoalveolar lavage is usually required to confirm the diagnosis and rule out infection. Diffuse alveolar hemorrhage dah resulting from pulmonary capillaritis typically accompanies the systemic vasculitides and collagen vascular diseases. Diffuse alveolar hemorrhage dah in patients with systemic lupus erythematosus is a rare but potentially fatal condition. Plasmapheresis therapy for diffuse alveolar hemorrhage in. We report a case of young male presenting with subacute respiratory failure. Diffuse alveolar hemorrhage in the icu springerlink. We report the case of a 28yearold woman admitted with acute respiratory failure. Apr 30, 20 diffuse alveolar hemorrhage dah is a lifethreatening and medical emergency that can be caused by numerous disorders and presents with hemoptysis, anemia, and diffuse alveolar infiltrates.
We describe the case of a 73yearold woman who presented with. Diffuse alveolar hemorrhage after allogeneic hematopoietic. Diffuse alveolar hemorrhage dah is a lifethreatening and medical emergency that can be caused by numerous disorders and presents with hemoptysis, anemia, and diffuse alveolar infiltrates. Acute diffuse alveolar the authors 2018 haemorrhage. We report the case of a 47yearold female who presented with hemoptysis, shortness of breath, and fever, but without any abdominal or joint symptoms, and no purpura on physical. Diffuse alveolar hemorrhage dah is a lifethreatening condition it is a subset of pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature most commonly the result of systemic vasculitis 1. Iga nephropathy with diffuse alveolar haemorrhage bmj case. Diffuse alveolar hemorrhage dah is a clinicopathologic syndrome describing the accumu lation of. A rare case of diffuse alveolar hemorrhage secondary to. Once the diagnosis is established, the underlying cause must be. Diffuse alveolar hemorrhage syndrome is characterized by the presence of blood in the pulmonary alveolus from arterioles, venules and pulmonary capillaries, as a consequence of a lesion of the alveolar wall and without an endobronchial alteration. Early identification of prognostic factors may be useful in the initiation of appropriate treatment.
Diffuse alveolar hemorrhage chest journal american college. We investigated the radiographic abnormalities that occurred in 39 transplantation patients with a diagnosis of diffuse alveolar hemorrhage and correlated the findings with the patients clinical course. Pulmonary manifestations of systemic lupus erythematosus. Diffuse alveolar hemorrhage from cocaine can be a lifethreatening condition making early identification and treatment crucial. Diffuse alveolar hemorrhage is a clinical syndrome that can be life.
He had been taking shoseiryuto for allergic rhinitis. Its presentation includes a classic triad of hemoptysis, anemia and diffuse alveolar infiltrates. Diffuse bilateral groundglass alveolar opacity advancing to confluent areas of consolidation. It typically presents with haemoptysis, anaemia and pulmonary infiltrates on chest radiograph. Diffuse alveolar hemorrhage is a clinical syndrome that can be life threatening if not diagnosed and treated in time. Iga nephropathy with diffuse alveolar haemorrhage bmj. Changes of acute or chronic organizing hemorrhage, sometimes with hyaline alveolar membranes, may accompany findings of smallvessel vasculitis or changes associated with the underlying pathology, such as granulomatous vasculitis in wegener granulomatosis table 1. We report a case of trepopnea associated with amiodaroneinduced diffuse alveolar hemorrhage. Successful rituximab therapy in a lupus patient with diffuse alveolar haemorrhage v pottier1, m pierrot1, jf subra2,3, a mercat1, a kouatchet1, a parrot4 and jf augusto2,3 1de. Management in the acute setting for diffuse alveolar haemorrhage relies on highdose glucocorticoids and supportive therapy. Diffuse alveolar haemorrhage dah is a rare complication of fat embolism syndrome leading to severe hypoxaemia due to the effusion of blood into the alveoli from the damaged pulmonary. Survival of patient depends on rapid diagnosis and the initiation of intensive immunosuppressive. Infectious diseases causing diffuse alveolar hemorrhage in. Diffuse alveolar haemorrhage secondary to ecigarette.
It is associated with many side effects, the most common being pulmonary manifestations. There are many causes of dah, including goodpastures syndrome, vasculitidies, and collagen vascular disease. Diffuse alveolar hemorrhage can complicate a large number of clinical conditions. In goodpastures syndrome, there is agreement that prompt institution of plasmapheresis, along with immunosuppressive therapy, can be lifesaving.
Even though we were unable to confirm the apla according to the recommendations the risk of positive apla status after 12 weeks for our patient is high considering the repeated subacute episodes. Here we present a case of vapingassociated diffuse alveolar hemorrhage. Pulmonary manifestations of systemic lupus erythematosus 315 and viral culture, cytology and for pneumocystis jiroveci stain. Diffuse alveolar hemorrhage is persistent or recurrent pulmonary hemorrhage. In patients suspected of having dah due to goodpastures syndrome. Diffuse alveolar haemorrhage diffuse alveolar haemorrhage is caused by disruption of the alveolar capillary basement membrane. Pdf diffuse alveolar hemorrhage dah is a lifethreatening and medical emergency that can be caused by numerous disorders and presents with. We report a case of pulmonary histoplasmosis where the initial presentation was pneumonia with a subsequent diagnosis. Diffuse alveolar hemorrhage dah is a clinical syndrome characterized by hemoptysis, the decrease of at least 2 grams of hemoglobin levels, hypoxemic respiratory failure, and the presence of new diffuse pulmonary infiltrates on a tomographic study. Although alveolar hemorrhage can be caused by infections, diffuse alveolar hemorrhage dah is considered to be a noninfectious pulmonary complication that usually occurs in the early posttransplant period. Case report open access leptospirosis as an important. This commentary focuses on the frequency, risk factors, pathogenesis, clinical manifestation, treatment, and prognosis of dah.
Reported prognosis is poor, with inhospital mortality ranging from 20% to 100%. Recognition of dah often requires bal as symptoms are nonspecific, hemoptysis is absent in up to onethird of patients, and radiographic imaging is also nonspecific and similar to other acute alveolar filling processes. Diffuse alveolar hemorrhage dah is bleeding into the alveolar spaces of the lung secondary to disruption of the alveolar capillary basement membrane. Diffuse alveolar hemorrhage dah is a rare disorder resulting from an accumulation of red blood cells originating from capillaries into the alveolar space. Diffuse alveolar hemorrhage and goodpastures syndrome. Pneumonitis with diffuse alveolar hemorrhage induced by shoseiryuto kazuo tsuchiya 1, mikio toyoshima and takafumi suda2 abstract.
The most known side effect of amiodarone use is chronic fibrosing alveolitis. Vaping has been associated with acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage, acute respiratory distress syndrome, hypersensitivity pneumonia, and giant cell interstitial pneumonitis. Diffuse alveolar hemorrhage dah is a subset of diffuse pulmonary hemorrhage when bleeding is diffuse and directly into the alveolar spaces. The pattern of opacification and the fact that the patient is on anticoagulant therapy is highly suggestive of diffuse alveolar hemorrhage dah. Clinical insights into diffuse alveolar hemorrhage in. Diffuse alveolar haemorrhage dah is a feature of several immune and nonimmune disorders. Early bronchoscopy with bronchoalveolar lavage is usually required to. Recognition of dah often requires bal as symptoms are nonspecific, hemoptysis is absent in up to onethird of patients, and radiographic imaging is also nonspecific and similar to other acute alveolar. Diffuse alveolar hemorrhage in autoimmune diseases springerlink. Diffuse alveolar hemorrhage dah is a serious pulmonary complication that occurs in patients undergoing hematopoietic stemcell transplantation hsct. Mohammed, md, fccp key facts terminology classifications based on immune status, immune complexes, histology, or presence of glomerulonephritis pulmonaryrenal syndrome imaging findings ct patterns nonspecific. Diffuse alveolar hemorrhage dah represents a medical emergency. Up to half of patients the episode of dah may be the first manifestation of the disease. Recognition of dah often requires bal as symptoms are nonspeci.
Ab0565 diffuse alveolar hemorrhage, diagnosis, treatment. When evident clinically, the condition is usually massive. The diagnosis should be suspected when a patient has even mild hemoptysis or has one of the diseases known to be associated with diffuse pulmonary hemorrhage. Bleeding into the alveolar spaces of the lungs characterizes the syndrome of diffuse alveolar hemorrhage dah and is due to disruption of the alveolar capillary basement membrane. Case report diffuse alveolar hemorrhage syndrome secondary. The causes of dah include a variety of noninfectious diseases, e. Trepopnea due to amiodaroneinduced diffuse alveolar. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage. Sep 20, 2016 diffuse alveolar hemorrhage tanlucien h. Abstractdiffuse alveolar hemorrhage is an acute, lifethreatening event, and repeated episodes can lead to organizing pneumonia, collagen. Diffuse alveolar haemorrhage dah is a lifethreatening syndrome caused by infection, coagulation disorders or autoimmune diseases. Recognition of dah often requires bal as symptoms are.
Acute diffuse alveolar haemorrhage accompanied by gastrointestinal bleeding in a patient with serious systemic lupus erythematosus. Diffuse alveolar hemorrhage dah is a rare and lifethreatening complication of cannabis abuse. Cannabis smoking is common among adolescents and young adults. Peters department of medicine, divisions of pulmonary and critical care medicine and hematology, mayo clinic and foundation. Diffuse alveolar haemorrhage in ancaassociated vasculitis. Cureus diffused alveolar hemorrhage in the setting of. Recombinant factor viia rfviia is an approved agent for the treatment of bleeding in. Crimean congo hemorrhagic fever and diffuse alveolar haemorrhage. Diffuse alveolar hemorrhage is not a specific disorder, but a syndrome that has a specific differential diagnosis and a specific sequence of testing.
Concurrent diffuse alveolar hemorrhage, pleural and pericardial effusion secondary to propylthiouracil abdullah sakkat, rebecca amer department of medicine, mcmaster university, hamilton, canada corresponding author. Notably, there was no evidence of diffuse alveolar damage suggesting ipfae. Diffuse alveolar hemorrhage in children sciencedirect. Diffuse alveolar hemorrhage in hematopoietic stem cell. Autopsied lungs revealed significantly dark redbrown appearance corresponding to diffuse alveolar haemorrhage dah histopathogically with a background pattern of uip with fibrotic change.
Bleeding into the alveolar spaces of the lungs characterizes the syndrome of diffuse alveolar hemorrhage dah and is due to disruption of the. Interstitial pneumonitis is one of the most common complications, however rarely amiodarone can cause diffuse alveolar haemorrhage dah too. Diffuse alveolar haemorrhage dah is a rare but serious and frequently lifethreatening complication of a variety of conditions. Resolution of diffuse alveolar haemorrhage after rituximab. Prs is an entity described as an acute renal failure with diffuse alveolar hemorrhage. Abdullah sakkat, 50 charlton ave e, firestone institute of respiratory health. Diffuse alveolar hemorrhage in a patient with antisynthetase. While histoplasmosis has been reported to cause hemoptysis and alveolar hemorrhage in children, the english language literature lacks any adult case reports documenting this association. The histologic appearance of diffuse alveolar hemorrhage figures is relatively uniform, whatever the underlying cause.
Diffuse alveolar hemorrhage in systemic lupus erythematosus. Castro, md diffuse alveolar damage dad is the histologic correlate of most patients with adult respiratory distress syndrome ards. Diffuse alveolar hemorrhage dah is a rare presentation of acute pulmonary histoplasmosis. Diffuse alveolar hemorrhage in patients with systemic lupus. It may present in different ways and may be lifethreatening, and it poses an important challenge for the clinician. Diffuse alveolar hemorrhage pulmonary disorders merck. We retrospectively analysed the charts of all patients referred to a university hospital for dah between.
This disruption is caused by injury or inflammation of the arterioles, venules, or alveolar septal alveolar wall or interstitial capillaries. Patients can present acutely with respiratory failure or more indolently with a history of worsening exercise intolerance and cough. Keywords diffuse alveolar hemorrhage infectious disease hemoptysis pulmonary disease introduction diffuse alveolar hemorrhage dah represents a syndrome with various presentations that can complicate many clinical conditions and may be lifethreatening, requiring prompt treatment 1. The diffuse alveolar hemorrhage syndromes uptodate. It is a relatively straight forward diagnosis and the. The most common findings include diffuse alveolar damage dad with or without alveolar hemorrhage and. The patient had no personal or familial medical history involving respiratory disease as asthma, thrombotic events or bleeding. It occurs in three distinct but overlapping phenotypes, acute capillaritis, bland pulmonary hemorrhage, and diffuse alveolar damage, each of which is associated with a different group of underlying conditions.
This paper describes chest xray cxr and computed tomography ct findings of diffuse alveolar haemorrhage dah. Most patients present with dyspnea, cough, hemoptysis, and new alveolar infiltrates on chest imaging. Pdf crimean congo hemorrhagic fever and diffuse alveolar. Diffuse pulmonary hemorrhage is an uncommon condition that is difficult to differentiate radiographically from diffuse pneumonia or pulmonary edema. Diffuse alveolar hemorrhage dah is often a catastrophic clinical syndrome causing respiratory failure. Dah is a distinct clinicopathologic syndrome of pulmonary hemorrhage that originates from the pulmonary microcirculation, including the alveolar. Systemic lupus erythematosus complicated by diffuse alveolar. Fatal diffuse alveolar haemorrhage mimicking acute. Dah refers to a clinical syndrome resulting from injury to the alveolar capillaries, arterioles, and venules leading to red blood cell accumulation in the distal air spaces because of leakage of alveolar capillaries. The outcome of treatment is dependent on causality. In most cases it occurs largely as a result of smallvessel vasculitis of the lungs.
Diffuse alveolar haemorrhage dah often mimics, clinically and radiologically, severe pneumonia or ards. Diffuse alveolar hemorrhage in patients with systemic. A case report jing du1, ying wang2, yanchun li5, tongtong wang3, yonglie zhou1 and zhenhua ying4 abstract systemic lupus erythematosus sle is an autoimmune disease that affects many organs, but. The onset of pulmonary hemorrhage is characterized by cough productive of blood hemoptysis and worsening of oxygenation leading to. Conclusions diffuse alveolar hemorrhage is a sudden lifethreatening event with a high mortality rate 46% in the acute phase and during the first 3 years after the acute episode 20% of survivors. Ab0565 diffuse alveolar hemorrhage, diagnosis, treatment and. Diffuse alveolar haemorrhage dah is a serious complication of antineutrophil cytoplasmic antibody ancaassociated vasculitis aav. Diffuse alveolar hemorrhage dah is a rare and potentially lifethreatening clinical. Diffuse alveolar haemorrhage associated with subsequent. Occasionally, patients with pulmonary infections and pneumonia may present with severe diffuse alveolar bleeding 2, 3. We describe the case of a 73yearold woman who presented with shortness of breath. Diffuse alveolar hemorrhage most commonly refers to bleeding from the lowpressure pulmonary vascular bed and is a rare cause of chronic interstitial lung disease in children. Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients bekele afessa, ayalew tefferi, mark r. Pdf diffuse alveolar hemorrhage dah is a rare life threatening condition characterized by bleeding into the alveolar spaces.
Occasionally a thoracoscopic lung biopsy may be needed. Amiodarone is an antiarrhythmic agent that is used commonly in clinical practice. Antiphospholipid antibodies apla are uncommonly associated with diffuse alveolar hemorrhage. A chest radiograph showed diffuse bilateral groundglass opacities with subpleural sparing. Pulmonary thromboembolism and diffuse alveolar hemorrhage. While diffuse alveolar hemorrhage dah is recognized as a lifethreatening complication of sle, little is known about its risk factors and response to therapy. Dah is characterized by bleeding into alveoli secondary to the disruption of the alveolar capillary basement membrane as a result of an injury at the level of alveolar microcirculation. In dah associated with sle, a regimen of corticosteroids combined with cyclophosphamide and plasma exchange is generally recommended. Nov 19, 2018 diffuse alveolar haemorrhage dah is a clinicalpathological syndrome with accumulation of red blood cells in the alveolar spaces due to injury of the pulmonary microcirculation, that can be caused by immune and coagulation disorders, heart disease, infections and drugs.
Pulmonary hemorrhage is present in 7 to 10% of neonatal autopsies, but up to 80% of autopsies of. She was a heavy smoker 15 cigarettes per day for the past five years and vaped electroniccigarettes ecigarettes one month prior to the incident. Rheumatoid arthritis causing diffuse alveolar haemorrhage. Flexible bronchoscopy revealed diffuse alveolar haemorrhage, and iga nephropathy was confirmed on a renal biopsy. Diffuse alveolar hemorrhage is a rare but serious complication of systemic lupus. Article diffuse alveolar hemorrhage applied radiology. Division of pulmonology, department of internal medicine, sever ance hospital, institute of chest diseases, yonsei university college of medicine, seoul, korea diffuse alveolar hemorrhage dah is a lifethreatening and medical emergency that can be caused by numerous. Data regarding diagnosis and treatment are limited to case series. Common causes include autoimmune diseases and connective tissue diseases. He was later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping. Its prognosis and factors associated with mortality are not completely clear, although invasive mechanical ventilation imv, use of cyclophosphamide, a high acute physiology and chronic health evaluation ii score, and infections are.
The patient was diagnosed with diffuse alveolar haemorrhage dah secondary to aav based on increased inflammatory reactions with positive myeloperoxidase. Clinical features of dah include dyspnea, a drop in hemoglobin, and diffuse radiographic alveolar images, with or without hemoptysis. Pneumonitis with diffuse alveolar hemorrhage induced by. Diffuse alveolar haemorrhage with anca associated vaculitis. Isolated pulmonary capillaritis and dah without systemic disease occurs in patients with antineutrophil cytoplasmic antibodies. It can be caused by elevated alveolar capillary hydrostatic pressure, increased alveolar capillary permeability, and exudates. We retrospectively analysed the charts of all patients referred to a university hospital for dah between 1980 and 2008. Diffuse pulmonary alveolar hemorrhage after bone marrow.
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