Pulmonary Vasculitis and Alveolar Hemorrhage

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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Diffuse Alveolar Hemorrhage After Orotracheal Extubation Probably Induced by Sevoflurane Inhalation

Archivos de Bronconeumología (English Edition) ◽

10.1016/j.arbr.2020.12.009 ◽

2021 ◽

Vol 57 (8) ◽

pp. 547-548

Author(s):

Mauro Carvalho Mendonça ◽

João Bettencourt Abreu ◽

Karina Gama

Keyword(s):

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage

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Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02697-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yumin Jo ◽

Jagyung Hwang ◽

Jieun Lee ◽

Hansol Kang ◽

Boohwi Hong

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Negative Pressure ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Unknown Etiology ◽

Anesthesia Care ◽

Monitored Anesthesia Care ◽

X Ray ◽

Chest X Ray

Abstract Background Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition that can present as a spectrum of nonspecific symptoms, ranging from cough, dyspnea, and hemoptysis to severe hypoxemic respiratory failure. Perioperative DAH is frequently caused by negative pressure pulmonary edema resulting from acute airway obstruction, such as laryngospasm, although hemorrhage itself is rare. Case presentation This case report describes an unexpected hemoptysis following monitored anesthesia care for vertebroplasty. A 68-year-old Asian woman, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. There were no noticeable events during the procedure. After the procedure, the patient was transferred to the postanesthesia care unit (PACU), at which sudden hemoptysis occurred. The suspected airway obstruction may have developed during transfer or immediate arrive in PACU. In postoperative chest x-ray, newly formed perihilar consolidation observed in both lung fields. The patients was transferred to a tertiary medical institution for further evaluation. She diagnosed with DAH for hemoptysis, new pulmonary infiltrates on chest x-ray and anemia. The patient received supportive care and discharged without further events. Conclusions Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.

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