J Rheum Dis.  2011 Jun;18(2):125-128.

A Case of a Patient with Dermatomyositis Who Developed a Diffuse Alveolar Hemorrhage

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea. kiwonmoon@paran.com

Abstract

Dermatomyositis is a inflammatory myopathy associated with interstitial lung disease in 5~10% of cases. The occurrence of diffuse alveolar hemorrhage (DAH) is considered exceptional in the course of dermatomyositis. We experienced a case of DAH in a 58-year-old female with dermatomyositis. DAH was diagnosed by anemia, infiltration on chest X-ray and computed tomography, and a bloody aspirate on bronchoscopy. Combined Pneumocystis jiroveci (PJP) pneumonia was suspected, as the polymerase chain reaction for PJP was positive. After intravenous the administration of immunoglobulin and treatment for the PJP, she markedly improved but subsequently developed nosocomial pneumonia and died.

Keyword

Dermatomyositis; Diffuse alveolar hemorrhage; Intravenous immunoglobulin

MeSH Terms

Anemia
Bronchoscopy
Dermatomyositis
Female
Hemorrhage
Humans
Immunoglobulins
Lung Diseases, Interstitial
Middle Aged
Myositis
Pneumocystis jirovecii
Pneumonia
Polymerase Chain Reaction
Thorax
Immunoglobulins

Figure

  • Figure 1. On admission, a chest radiograph showed bilateral diffuse reticular haziness in panel (A). On hospital day 2, a chest radiograph showed increased haziness, especially in the left lower lung field, in panel (B), after an intravenous immunoglobulin infusion, a chest radiograph showed much improved bilateral diffuse haziness in panel (C).

  • Figure 2. On hospital day 2, a high-resolution chest computed tomography scan showed bilateral diffuse ground glass opacity with interlobular septal wall thickening.

  • Figure 3. Sequential Bronchoalveolar lavage showed lavage aliquots were more progressively hemorrhagic.


Reference

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