SHM Converge Scientific Abstract ePoster Gallery-Diffuse Alveolar Hemorrhage as an Uncommon Granulomatosis With Polyangiitis

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This case report describes an uncommon presentation of Granulomatosis with Polyangiitis (GPA), a rare necrotizing vasculitis that typically affects the upper airways, lungs, and kidneys. GPA has an unknown cause and can be difficult to diagnose because its symptoms are highly variable. Diffuse alveolar hemorrhage (DAH) is one of the rarest pulmonary manifestations of GPA and usually presents with hemoptysis, anemia, diffuse infiltrates on imaging, and hypoxemic respiratory failure.<br /><br />A 74-year-old man developed progressive generalized edema and shortness of breath over several months. He was initially treated for heart failure without improvement, and later presented with hemoptysis. Examination showed bilateral pretibial edema, chronic hyperpigmentation of the lower extremities, decreased breath sounds, and right-sided rales. Laboratory and imaging studies revealed positive ANCA, bilateral patchy interstitial opacities, a moderate right pleural effusion, and atelectasis. Bronchoscopy showed blood throughout the bronchial tree, though no specific bleeding source was identified. BAL demonstrated mild chronic inflammation, and infectious and malignant causes were excluded. Wedge biopsy findings, including alveolar hemorrhage and focal chronic inflammation, were consistent with ANCA-associated vasculitis.<br /><br />The patient improved after pleural drainage and treatment with rituximab and corticosteroids. The report emphasizes that GPA is often underdiagnosed, especially when it presents with uncommon features like DAH. Because the classic DAH triad is incomplete in many cases and symptoms are nonspecific, clinicians should maintain a high index of suspicion. Early recognition of hemoptysis, new infiltrates, anemia, and bloody BAL fluid can speed diagnosis and treatment, which is important given the condition’s potential severity and mortality risk.

Asset Subtitle

Azfar Hameed

Meta Tag

Author List Aashish Anunaya, Ana L. Chavez Velasquez, Azfar Hameed, Elizabeth Chandy, Jamal Mubarak, Kamran Chaudhry, Richard Ward, Sridhar Iyer

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Diffuse Alveolar Hemorrhage

Concept Necrotizing Vasculitis

Concept Granulomatous Inflammation

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Azfar Hameed

Track Adult

Keywords

Granulomatosis with Polyangiitis

GPA

Diffuse Alveolar Hemorrhage

ANCA-associated vasculitis

Hemoptysis

Pleural effusion

Bronchoscopy

Rituximab

Corticosteroids

Hypoxemic respiratory failure

Granulomatosis with Polyangiitis

Diffuse Alveolar Hemorrhage

Necrotizing Vasculitis

Granulomatous Inflammation

Corticosteroids