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Recurrent diffuse alveolar hemorrhage in Immunoglobulin A vasculitis

Year: 2025

Type: article

Abstract: Introduction: Immunoglobulin A vasculitis (IgAV) is a small-vessel immune complex-mediated vasculitis that predominantly affects children, with significantly fewer cases reported in adults. When IgAV does occur in adults, it often presents with more severe systemic involvement and worse renal outcomes compared to pediatric populations. A rare pulmonary complication of IgAV is diffuse alveolar hemorrhage (DAH). We present a case of recurrent hypoxic respiratory failure with DAH in a patient found to have biopsy proven IgAV. Case description: A man in his 60s was admitted with recurrent hypoxia following recent hospitalization for presumed pneumonia. Shortly after admission, he experienced cardiac arrest. He was intubated and had a return of spontaneous circulation. He was transferred to the ICU and underwent bronchoscopy with bronchoalveolar lavage (BAL). This revealed bloody aliquots and eosinophilia. Infectious workup was negative. Autoimmune serologies were negative. Serum inflammatory markers were elevated. Worsening kidney function raised concern for a pulmonary-renal syndrome and high-dose intravenous methylprednisolone was initiated empirically with improvement in clinical status. Renal biopsy was performed which confirmed IgA vasculitis. After seven days, the patient returned to the hospital with recurrent hypoxia and a new cavitary lung lesion. Repeat bronchoscopy with BAL was performed which was concerning for DAH. The patient was initiated on high dose IV steroids and IV cyclophosphamide. Shortly after, the patient elected for comfort care and was discharged to in-patient hospice. Discussion: This case underscores the importance of timely immunosuppressive therapy and multidisciplinary care. However, prognosis remains poor in patients with severe systemic involvement.

Source: Respiratory Medicine Case Reports

DOI: 10.1016/j.rmcr.2025.102357

Authors: Joshua Woods, Baldeep Mann, Mehul Patel

Institution: Eisenhower Medical Center

Language: English

Topic: Vasculitis and related conditions

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,200