Korean J Crit Care Med.  2016 May;31(2):173-177. 10.4266/kjccm.2016.31.2.173.

Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust

• Choi SM
• Koh J
• Lee SM
• Lee J

• KMID: 2350928
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.173

Abstract

Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

Keyword

hemoptysis; hemorrhage; organic; respiratory insufficiency

MeSH Terms

Adrenal Cortex Hormones
Adult
Anti-Bacterial Agents
Biopsy
Bronchoalveolar Lavage
Diagnosis, Differential
Dust*
Fibroblasts
Hemoptysis
Hemorrhage*
Humans
Intensive Care Units
Lung
Macrophages
Respiration, Artificial
Respiratory Insufficiency*
Adrenal Cortex Hormones
Anti-Bacterial Agents
Dust

Figure

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  Fig. 1. Initial chest radiographic findings. (A) Initial chest radiograph of the patient showing diffuse bilateral infiltration. (B) Chest computed tomography showing diffuse ground glass opacities and consolidation with centrilobular pattern involving both lungs suggesting diffuse alveolar hemorrhage or acute hypersensitivity pneumonitis.

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  Fig. 2. Result of bronchoalveolar lavage. Bronchoalveolar lavage showing typical progressively bloody returns in the sequential aliquots.

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  Fig. 3. Summary of key events and the treatment. MPD: methylprednisolone; NO: nitrous oxide; HD: hospital day; ED: emergency department; EICU: emergency intensive care unit; MV: mechanical ventilation.

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  Fig. 4. Histopatholgic findings of open lung biopsy. (A) Diffuse accumulation of red blood cells in the alveolar spaces and interstitial thickening are observed, consistent with diffuse alveolar hemorrhage and organization (hematoxylin and eosin staining (H&E), x100). (B) Some fibroblastic foci are noted in the specimen (H&E, x200). (C) Numerous hemosiderin-laden macrophages and hyperplasia of type II pneumocytes are observed, representing alveolar hemorrhage (H&E, ×400).

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  Fig. 5. Improved chest radiographic findings after steroid treatment. Chest radiograph of the patient taken on the day of discharge showing that the previously noted bilateral infiltrations have resolved.

Reference

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