Diffuse Alveolar Hemorrhage after Receiving Oral Levonorgerstrel for Emergency Contraception: A Case Report

Abstract

Introduction: Drug-induced diffuse alveolar hemorrhage (DAH) has been associated with the administration of various medications, among which levonorgestrel (LN) has not been reported until now.

Case presentation: This case study describes a 42-year-old woman who presented with hemoptysis, hypoxemia, and radiological depiction of ground glass opacities, 3 days after she had received emergency contraceptive medication containing levonorgestrel. Emergent bronchoscopy was performed, and BAL was diagnostic of diffuse alveolar hemorrhage (DAH). A thorough diagnostic approach was followed, in order to detect the underlying pathological condition that induced DAH. The absence of other identifiable pathological conditions in this patient raised suspicion of LN's potential causative role.

Conclusion: DAH has not been reported as an adverse effect of LN until now. However, LN has been found to exert immunomodulatory effects and to present potential for manifestations of vasculitis as well as severe hypersensitivity reactions. These mechanisms may have been implicated in the development of DAH in our patient, who presented no other pathological conditions.

Keywords: Diffuse alveolar hemorrhage (DAH); emergency contraception; levonorgestrel; progesterone derivative; progestogen.

Figure 1.

Chest X-ray depicted no pathological findings–despite the patient’s symptoms of cough and hemoptysis.

Figure 2.

CT scan of the thorax revealed multiple confluent ground glass and botryoid nodules throughout the right lung, but also to a lesser extent in the left lung. There is a thickening of the wall of the central bronchi of the right lower lobe as well. Based on the reported history, the imaging findings are primarily in favor of diffuse alveolar haemorrhage. An incidental finding of an aneurysm, maximum diameter 4 cm, was also depicted in the ascending aorta, without clinical denotation.

Figure 3.

CT scan of the thorax 1 month later revealed resolution of the ground glass opacities that had been depicted 1 month ago. The dimensions of the ascending aorta were measured the same.

Figure 4.

Symptoms and signs, diagnostic approach, therapeutic intervention, and follow-up shown in timeline schedule.