B64-55 Diffuse Alveolar Hemorrhage Associated With Mycoplasma Pneumoniae in an Immunocompetent Woman Presenting With Decompensated Cirrhosis

Abstract Diffuse Alveolar Hemorrhage (DAH) is a life-threatening syndrome characterized by intra-alveolar bleeding that results in hypoxemic respiratory failure. While commonly associated with autoimmune diseases, vasculitides, and hematologic disorders, infection-related DAH—particularly secondary to Mycoplasma pneumoniae—is exceedingly rare. We present the case of a 46-year-old woman with cirrhosis and psoriatic arthritis who was admitted with abdominal distention, jaundice, and non-bloody emesis. Imaging revealed significant ascites. Shortly after admission, she developed worsening hypoxemia with new bilateral pleural effusions and diffuse ground-glass opacities. Mycoplasma pneumoniae infection was confirmed by positive IgM serology. Despite antibiotic therapy, her respiratory status deteriorated, necessitating intubation for acute hypoxemic respiratory failure. On hospital day two, she developed hemoptysis. Initial bronchoscopy with serial bronchoalveolar lavage (BAL) was negative for DAH. Following extubation after six days, her hypoxemia recurred with a notable drop in hemoglobin and persistent hemoptysis, prompting repeat bronchoscopy, which confirmed DAH. Autoimmune and vasculitis workup, including ANCA and anti-GBM antibodies, was negative. Plasma exchange (PLEX) was initiated, but her condition progressed to hemorrhagic shock, and she ultimately succumbed to her illness.This case illustrates an atypical presentation of DAH in an immunocompetent patient with Mycoplasma pneumoniae infection and decompensated cirrhosis. Fewer than a dozen cases of Mycoplasma-associated DAH have been reported. Although cirrhosis is not a direct etiologic factor, its rebalanced hemostatic state—characterized by concurrent pro- and antithrombotic tendencies—may have contributed to alveolar bleeding. Moreover, while DAH has been linked to autoimmune diseases such as ANCA-associated vasculitis, systemic lupus erythematosus, and rheumatoid arthritis, no such association has been described with psoriatic arthritis. Clinicians should maintain a high index of suspicion for DAH in patients with new or worsening hypoxemia and anemia, even in the absence of classic autoimmune or hematologic risk factors. Early recognition and targeted management remain critical to improving outcomes in this rare and rapidly progressive condition. This abstract is funded by: none