Kim Tae Gyoung, Kang Jiyeon, Seo Woo Jung, Kang Jieun, Park So-Hee, Koo Hyeon-Kyoung, Park Hye Kyeong, Lee Sung-Soon, Kim Jung Gon, Kang Hyung Koo
Department of Internal Medicine Inje University Ilsan Paik Hospital Goyang Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine Inje University Ilsan Paik Hospital Goyang Republic of Korea.
Respirol Case Rep. 2023 Feb 7;11(3):e01097. doi: 10.1002/rcr2.1097. eCollection 2023 Mar.
Diffuse alveolar haemorrhage (DAH) is a life-threatening condition caused by widespread damage to the small pulmonary vessels. Common chest imaging findings in patients with DAH show bilateral diffuse airspace opacities. DAH complicating antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, including microscopic polyangiitis, should be considered as a differential diagnosis in patients with progressive dyspnea, reduced haemoglobin levels, and alveolar opacities on chest imaging. We report the case of a 78-year-old woman who presented with unilateral DAH, severe dyspnea, and anaemia. DAH was confirmed using bronchoalveolar lavage. Laboratory test results, including ANCA, positive anti-myeloperoxidase antibody, and negative anti-proteinase 3, led to a diagnosis of microscopic polyangiitis. Rituximab and methylprednisolone were administered. The patient's symptoms, laboratory test results, and chest radiography findings improved after the initiation of treatment. This case highlights the importance of prompt recognition of clinical symptoms and signs, including dyspnea and anaemia, for the diagnosis of DAH.
弥漫性肺泡出血（DAH）是一种由小肺血管广泛损伤引起的危及生命的病症。DAH患者常见的胸部影像学表现为双侧弥漫性气腔混浊。DAH合并抗中性粒细胞胞浆抗体（ANCA）相关血管炎，包括显微镜下多血管炎，对于进行性呼吸困难、血红蛋白水平降低且胸部影像学显示肺泡混浊的患者应考虑作为鉴别诊断。我们报告一例78岁女性患者，其表现为单侧DAH、严重呼吸困难和贫血。通过支气管肺泡灌洗确诊为DAH。包括ANCA、抗髓过氧化物酶抗体阳性及抗蛋白酶3阴性在内的实验室检查结果导致诊断为显微镜下多血管炎。给予利妥昔单抗和甲泼尼龙治疗。治疗开始后患者的症状、实验室检查结果及胸部X线表现均有改善。该病例强调了及时识别包括呼吸困难和贫血在内的临床症状和体征对于DAH诊断的重要性。
