Diffuse alveolar hemorrhage (DAH) in the immediate post-transplant setting: An unusual case and a review of literature

Abstract

Diffuse alveolar hemorrhage is known to be a devastating clinical condition with myriad etiologies. The immediate post-transplant period is plagued by immunosuppression, surgical complications, and nosocomial sources of infection. Diffuse alveolar hemorrhage in this setting is usually attributed to infection. In this case report, an unusual cause of diffuse alveolar hemorrhage due to anti-thymocyte globulin used as an induction agent is described, and an approach to DAH in the immediate post-transplant setting is discussed.

Diffuse alveolar haemorrhage – case report and literature review

“…Aliquot of bronchoalveolar lavage (BAL) that features ≥20% haemosiderophages confirms alveolar haemorrhage, and is also associated with severity [5,10]. After diagnosis, the next step is origin conformation [12] which determines treatment strategy [3]. In this case, infectious etiologies were considered and excluded, due to negative samples from nasopharyngeal swab and urine sample.…”

“…(Tab. 4) Autoantibody panels for antinuclear antibodies (ANA), ANCA, rheumatoid factor (RF), antiphospholipid antibodies (APL), antibodies, anti-glomerular basement membrane (GBM), lupus anticoagulant, anti-cardiolipin (CL) antibodies, anti-β-2 glycoprotein1 (β2GP),) also should be performed [10,12]. In some cases even an open lung or surgical biopsy might be needed to identify the origin [9].…”

“…To exclude heart failure echocardiogram should be performed to rule out pulmonary oedema and valvular pathologies [14]. Besides treatment of the origin supportive therapy consisting of mechanical ventilation and oxygen perfusion and BAL are also needed [12,15]. Because the main pathophysiology of DAH is the inflammatory process, corticosteroids and immunosuppressive therapies are the standard treatment [5,6].…”