Alveolar Hemorrhage in Vasculitis: Primary and Secondary

Jean-François Cordier; Vincent Cottin

doi:10.1055/s-0031-1279827

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2011; 32(3): 310-321
DOI: 10.1055/s-0031-1279827

Alveolar Hemorrhage in Vasculitis: Primary and Secondary

Jean-François Cordier¹ , Vincent Cottin¹

¹Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Louis Pradel University Hospital, Lyon, France

Abstract

ABSTRACT

Diffuse alveolar hemorrhage (DAH) in primary and secondary vasculitis occurs when capillaritis is present. The diagnosis of DAH is considered in patients who develop progressive dyspnea with alveolar opacities on chest imaging (with density ranging from ground glass to consolidation) that cannot be explained otherwise. Hemoptysis, a valuable sign, is often absent. A decline of blood hemoglobin level over a few days without hemolysis or any hemorrhage elsewhere should be an alert for DAH. Bronchoalveolar lavage, retrieving bright red fluid, is the best diagnostic clue. Lung biopsy is not recommended. A search for anti-neutrophil cytoplasmic autoantibodies (ANCAs) is mandatory. Once DAH is diagnosed and hemodynamic as well as infectious causes have been excluded, ANCA-associated vasculitis is taken into account (mainly microscopic polyangiitis or Wegener granulomatosis, and, exceptionally, Churg-Strauss syndrome). Drug-induced DAH, especially antithyroid drugs such as propylthiouracil may be coupled with ANCA. Isolated DAH with capillaritis with or without ANCA is rare. DAH in systemic lupus erythematosus is either associated or not with capillaritis. Treatment of DAH should target the underlying disorder. In the primary vasculitides, corticosteroids and immunosuppressants, especially cyclophosphamide, are the mainstay of therapy, but plasma exchange, particularly in severe DAH, is the rule, although evidence of its effectiveness is awaited.

KEYWORDS

Alveolar hemorrhage - vasculitis - drug-induced lung disease - connective tissue disease

Full Text

References

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Jean-François CordierM.D.

Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Louis Pradel University Hospital

69677 Lyon (Bron), France

Email: jean-francois.cordier@chu-lyon.fr