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Diffuse alveolar hemorrhage as the presenting feature of an IgA vasculitis: An unusual presentation

Aniqa Malik, Hany Eskarous, Gerson De Freitas, Divakar Sharma, Mahesh Krishnamurthy & Jolanta Zelaznicka

IgA vasculitis is the most common form of systemic vasculitis in children, but only 10% of the cases occur in adults. It typically presents with symptoms of palpable purpura, arthralgia, abdominal pain and renal disease. Diffuse alveolar hemorrhage is a rare feature of IgA vasculitis, with only a small number of cases reported to date. We report the case of a 47-year-old female who presented with hemoptysis, shortness of breath, and fever, but without any abdominal or joint symptoms, and no purpura on physical examination. She also had hematuria and proteinuria, but normal kidney function otherwise. Chest imaging revealed patchy nodular consolidations in bilateral lungs, which raised concern for pneumonia or vasculitis. A bronchoscopy was subsequently done, revealing diffuse alveolar hemorrhage. Renal biopsy was then performed, with pathology yielding focal segmental and crescentic glomerulonephritis, consistent with IgA vasculitis. The patient was treated with intravenous methylprednisolone 1 g per a day for three days followed by tapering dose of oral prednisone, with complete improvement of her respiratory symptoms.