Two Immunocompromised Patients With Diffuse Alveolar Hemorrhage as a Complication of Severe Coronavirus Disease 2019

Christian Löffler; Juliane Mahrhold; Peter Fogarassy; Martin Beyer; Bernhard Hellmich

doi:10.1016/j.chest.2020.06.051

Two Immunocompromised Patients With Diffuse Alveolar Hemorrhage as a Complication of Severe Coronavirus Disease 2019

Chest. 2020 Nov;158(5):e215-e219. doi: 10.1016/j.chest.2020.06.051. Epub 2020 Jul 2.

Authors

Christian Löffler¹, Juliane Mahrhold², Peter Fogarassy³, Martin Beyer³, Bernhard Hellmich²

Affiliations

¹ Department of Internal Medicine, Rheumatology and Immunology, medius Klinik Kirchheim, Academic Teaching Hospital University of Tübingen, Kirchheim unter Teck, Germany. Electronic address: [email protected].
² Department of Internal Medicine, Rheumatology and Immunology, medius Klinik Kirchheim, Academic Teaching Hospital University of Tübingen, Kirchheim unter Teck, Germany.
³ Department of Internal Medicine, Cardiology and Intensive Care Medicine, medius Klinik Kirchheim, Academic Teaching Hospital University of Tübingen, Kirchheim unter Teck, Germany.

Abstract

Diffuse alveolar hemorrhage (DAH) is a severe and potentially life-threatening disease manifestation. In addition to autoimmune diseases such as antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane syndrome, pulmonary viral infections are known to be culprits of DAH. Health-care providers worldwide in the coronavirus disease 2019 pandemic have been confronted with an unprecedented number of viral lung infections, with great variance in symptoms and severity. Hemoptysis, the key symptom of DAH, is a rare complication. We present two cases of immunocompromised patients with rapidly developing hypoxemic respiratory failure and evidence of DAH in the context of severe acute respiratory syndrome coronavirus 2 infection.

Keywords: COVID-19; coronavirus disease; diffuse alveolar hemorrhage.

Publication types

Case Reports

MeSH terms

Aged
Aortitis / complications
Aortitis / drug therapy
Aortitis / immunology
Autoimmune Diseases / complications
Autoimmune Diseases / drug therapy
Autoimmune Diseases / immunology
Betacoronavirus
COVID-19
Carcinoma, Transitional Cell / complications
Carcinoma, Transitional Cell / immunology
Carcinoma, Transitional Cell / therapy
Chemoradiotherapy
Coronavirus Infections / complications*
Coronavirus Infections / immunology
Coronavirus Infections / physiopathology
Cross Infection
Glucocorticoids / therapeutic use
Hemoptysis / etiology
Hemorrhage / etiology*
Humans
Hypereosinophilic Syndrome / complications
Hypereosinophilic Syndrome / drug therapy
Hypereosinophilic Syndrome / immunology
Hypoxia / physiopathology
Immunocompromised Host*
Immunosuppressive Agents / therapeutic use
Lung Diseases / etiology*
Male
Pandemics
Pneumonia, Viral / complications*
Pneumonia, Viral / immunology
Pneumonia, Viral / physiopathology
Prednisolone / therapeutic use
Respiratory Insufficiency / physiopathology
SARS-CoV-2
Urinary Bladder Neoplasms / complications
Urinary Bladder Neoplasms / therapy

Substances

Glucocorticoids
Immunosuppressive Agents
Prednisolone