SHM Converge Scientific Abstract ePoster Gallery-A Case of Iga Vasculitis With Diffuse Alveolar Hemorrhage

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This case describes a 68-year-old man with IgA vasculitis/IgA nephropathy complicated by diffuse alveolar hemorrhage (DAH), a rare and life-threatening pulmonary manifestation. He presented with one month of a pruritic palpable purpuric rash, shortness of breath, hemoptysis, and worsening edema. His past medical history included hypertension, NAFLD, OSA, depression/anxiety, diabetes, and obesity. On exam, he had widespread palpable purpura over the lower extremities and upper extremities, along with pitting edema. Initial labs showed anemia, elevated D-dimer, and later urine microscopy revealed hematuria and proteinuria, supporting renal involvement.<br /><br />Extensive serologic testing for alternative causes of vasculitis and pulmonary hemorrhage was negative, including ANCA, anti-GBM, ANA, infectious studies, and complement levels were normal. Chest CT angiography showed bilateral ground-glass opacities concerning for DAH. Bronchoscopy with bronchoalveolar lavage demonstrated progressively bloodier aliquots, confirming alveolar hemorrhage. Renal biopsy showed exudative glomerulonephritis with IgA-dominant mesangial deposits, consistent with IgA nephropathy/Henoch-Schönlein purpura.<br /><br />The patient’s respiratory status worsened and required intubation. He was treated with pulse-dose methylprednisolone 1 g daily for 3 days followed by a steroid taper, with subsequent clinical improvement. He was extubated, transferred for further rheumatologic care, and discharged to acute rehabilitation on low-flow oxygen.<br /><br />This case highlights that pulmonary and renal manifestations of IgA vasculitis/nephropathy may occur independently, and DAH should be considered when patients present with hemoptysis and bilateral ground-glass opacities. Early biopsy of skin lesions is important because diagnostic yield decreases after 24–48 hours and steroid treatment can obscure histology. Steroids remain the mainstay of therapy, with additional immunosuppression considered in severe cases.

Asset Subtitle

Pritee Shrestha

Meta Tag

Author List Pritee Shrestha

Category Clinical Vignettes

Concept Diffuse Alveolar Hemorrhage

Concept IgA Nephropathy

Concept IgA Vasculitis

Concept Pulmonary Complication

Concept Diagnosis

Distinguished Non-Finalist

Presenter Organization Mercy One North Iowa Internal Medicine Residency

Presenting Author Pritee Shrestha

Track Adult

Keywords

IgA vasculitis

IgA nephropathy

diffuse alveolar hemorrhage

hemoptysis

palpable purpura

glomerulonephritis

bronchoalveolar lavage

ground-glass opacities

methylprednisolone

renal biopsy

Diffuse Alveolar Hemorrhage

IgA Nephropathy

IgA Vasculitis

Pulmonary Complication

Diagnosis