What question did this study set out to answer?

To highlight the rare presentation of p-ANCA-associated vasculitis with diffuse alveolar hemorrhage and hearing loss.

June 26, 2026Open Access

Diffuse Alveolar Hemorrhage As the Presenting Feature of Perinuclear Antineutrophil Cytoplasmic Antibody (p-ANCA)-Associated Vasculitis Preceded by Hearing Loss: A Case Report

Key Points

To highlight the rare presentation of p-ANCA-associated vasculitis with diffuse alveolar hemorrhage and hearing loss.
Case report of a 21-year-old woman presenting with symptoms of diffuse alveolar hemorrhage and hearing loss.
Imaging and bronchoalveolar lavage conducted to confirm the diagnosis.
Treatment with intravenous methylprednisolone followed by oral corticosteroids.
Patient experienced severe diffuse alveolar hemorrhage with acute respiratory failure and hypoxemia.,
Bilateral hearing loss prior to respiratory symptoms may indicate early vasculitis manifestation.,
Rapid recovery and extubation achieved following immunosuppressive therapy.

Abstract

Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary emergency that may occur as a manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We report a rare case of perinuclear antineutrophil cytoplasmic antibody (p-ANCA)-positive vasculitis presenting with severe DAH without renal involvement, preceded by acute bilateral hearing loss. A previously healthy 21-year-old woman presented with hemoptysis, severe hypoxemia, and respiratory failure requiring mechanical ventilation. Chest imaging showed bilateral diffuse infiltrates and ground-glass opacities. Bronchoalveolar lavage findings were consistent with DAH. Serologic workup revealed positive p-ANCA with negative cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and anti-glomerular basement membrane (anti-GBM) antibodies. Renal function and urinalysis remained normal throughout admission. The patient was treated with pulse intravenous methylprednisolone followed by oral corticosteroids, leading to rapid clinical improvement and successful extubation within five days. Further history revealed bilateral hearing loss one week before presentation, which may represent a possible early otologic manifestation of vasculitis. This case highlights that ANCA-associated vasculitis may present as isolated DAH without renal involvement, while unexplained hearing loss may provide an early clue to underlying AAV before the onset of life-threatening pulmonary manifestations. Early recognition and prompt immunosuppressive therapy are essential to improve outcomes.

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