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Case Reports
. 2021 Jun 15;60(12):1911-1914.
doi: 10.2169/internalmedicine.5219-20. Epub 2021 Feb 1.

Diffuse Alveolar Hemorrhage Associated with Dilated Cardiomyopathy and Sleep Apnea Syndrome

Ryohei Suematsu  1 , Jun Miyata  1 , Tomoya Sano  1 , Chie Watanabe  1 , Yohei Maki  1 , Yoshifumi Kimizuka  1 , Nobuyoshi Hayashi  1 , Yuji Fujikura  1 , Hiroaki Sugiura  2 , Hiroshi Shinmoto  2 , Akira Taruoka  3 , Yuji Nagatomo  3 , Takeshi Adachi  3 , Akihiko Kawana  1
Affiliations
Case Reports

Diffuse Alveolar Hemorrhage Associated with Dilated Cardiomyopathy and Sleep Apnea Syndrome

Ryohei Suematsu et al. Intern Med. .

Abstract

We herein report a case of diffuse alveolar hemorrhage (DAH) associated with dilated cardiomyopathy (DCM) and sleep apnea syndrome (SAS) in a 47-year-old man. The patient exhibited recurring dyspnea and bloody sputum. Chest radiography showed bilateral diffuse infiltrative opacities without pleural effusion. A bronchoscopic analysis of bronchoalveolar lavage fluid revealed hemosiderin-laden macrophages. Based on these findings, he was diagnosed with DAH. Laboratory and pathological findings ruled out the possibility of collagen diseases and vasculitis. Overnight polysomnography revealed concomitant severe obstructive SAS. Treatment with continuous positive-pressure ventilation and pharmacological therapy for DCM prevented recurrence of DAH.

Keywords: anemia; diffuse alveolar hemorrhage; dilated cardiomyopathy; negative pressure pulmonary hemorrhage; sleep apnea syndrome.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Chest radiography showed bilateral infiltration, and (B, C) computed tomography showed bilateral diffuse ground glass opacity without pleural effusion.
Figure 2.
Figure 2.
(A) Chest radiography showed bilateral infiltration, and (B, C) computed tomography showed marked improvement of the bilateral diffuse ground glass opacity.
Figure 3.
Figure 3.
(A) Chest radiography and (B, C) computed tomography showed newly emerging consolidation in the right upper lobe.
Figure 4.
Figure 4.
(A) Bronchoscopy revealed bloody effusion in the right upper bronchus. (B) A cytological examination of the bronchoalveolar lavage fluid showed hemosiderin-laden macrophages. (C) Bronchoalveolar lavage showed hemoid deposits.
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