Abstract Background Diffuse alveolar hemorrhage (DAH) is a life-threatening condition characterized by hemoptysis, hypoxia, diffuse infiltrates, and respiratory failure. Common causes include autoimmune-mediated capillaritis, vasculitis, and drug exposures. Prompt diagnosis and treatment are critical. Case A 19-year-old female with a history of first-time seizures presented with acute hemoptysis and hypoxia. Chest imaging revealed bilateral patchy consolidative opacities and ground-glass infiltrates. She denied inhalational drug use but admitted to occasional marijuana use. On hospital day one, she experienced a seizure requiring critical care admission. She continued having hemoptysis which required intubation. Bronchoscopy confirmed diffuse alveolar hemorrhage. Comprehensive work-up, including infectious, autoimmune, and vasculitis panels (ANCA, ANA, etc.), were all negative. After extensive work-up, the underlying etiology remained unknown. She was treated with pulse-dose corticosteroids followed by prednisone 60 mg daily. Her respiratory status improved significantly, and she was extubated and discharged on room air. Discussion In DAH, identifying the underlying etiology is essential to guide treatment. This case underscores the diagnostic challenge when routine infectious, rheumatologic, and toxicology work-up is negative. In such cases, the diagnosis of Idiopathic DAH is made and empiric steroid therapy may still be beneficial, though it should be done cautiously and after ruling out infections. Conclusion This case highlights an unusual presentation of DAH without an identifiable cause. When extensive work-up is inconclusive, a monitored steroid trial may be a reasonable therapeutic approach with potentially favorable outcomes. Citations: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e. McGraw-Hill Education; 2018. Accessed March 25, 2024. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=159213747 Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164-1171. doi:10.1378/chest.08-2084 Park MS. Diffuse alveolar hemorrhage. Tuberc Respir Dis (Seoul). 2013;74(4):151-162. doi:10.4046/trd.2013.74.4.151 This abstract is funded by: None
Cabrera et al. (Fri,) studied this question.