The Importance of Clinical History in the Etiological Diagnosis of Diffuse Alveolar Hemorrhage Associated With Improper Adrenaline Use

This case involves a 21-year-old male healthcare student with a medical history of HIV-1 infection for two years and anxiety disorder. He presented to the emergency department with hemoptysis and dyspnea of sudden onset. A thoracic CT scan revealed multiple bilateral nodular ground-glass opacities suggestive of diffuse alveolar hemorrhage (DAH). Due to hypoxemic respiratory failure, noninvasive ventilatory support was initiated. A bronchoalveolar lavage confirmed the presence of blood. He also showed an elevated troponin I, peaking at 2,915 ng/mL, with no electrocardiographic or echocardiographic abnormalities. Assuming an immune etiology, high-dose corticosteroids were initiated, with three days of methylprednisolone 1 g. However, the entire etiological study for DAH turned out negative. During a follow-up clinical interview, the patient admitted to having self-administered 1 mg of intravenous adrenaline shortly before the onset of symptoms. The patient showed a favorable evolution, with no recurrence of symptoms, allowing for oxygen therapy weaning. A follow-up chest CT on the ninth day of hospitalization showed no significant alterations. This case highlights the importance of a thorough history in determining the etiology of a potentially fatal disease, adding intravenous epinephrine as a potential trigger of hemoptysis due to exogenous agents.