Pulmonary Alveolar Hemorrhage

Abstract

Diffuse alveolar hemorrhage (DAH), a rare disease, is a therapeutic emergency as it can lead quickly to asphyxiating acute respiratory failure (ARF) with death. The triad, hemoptysis-anemia-radiological infiltration, suggests the diagnosis of DAH, but it may be missed in two-thirds of cases, including the patients with respiratory distress. Thoracic computed tomography can help in atypical forms. The diagnosis of DAH is based on performing a bronchoalveolar lavage and the etiologies are numerous. It will be important to separate non-immune DAH with septic-derived DAHs that should benefit from targeted microbiological investigation and cardiovascular disease by performing a cardiac ultrasound, from the immune DAHs (anti-cytoplasmic anti-neutrophil cytoplasmic vasculitis, connective tissue diseases and Goodpasture’s syndrome) with research on autoantibodies and performing biopsies at easily accessible organs. Pulmonary biopsy must remain exceptional. In case of inaugural immune DHA, treatment with steroids and cyclophosphamide can be started. Indications for rituximab are beginning to be better established. The benefit of plasma exchange is debated. In case of recurrence of pulmonary infiltrates, in a patient followed for an immune DHA, we would strive to rule out an infection at first.