Massive Alveolar Haemorrhage Presenting During the COVID-19 Pandemic

Abstract

The coronavirus disease (COVID-19) pandemic has challenged healthcare systems and has resulted in complex diagnostic processes for patients with non-COVID-19 pathology. Here, we demonstrate a case of massive alveolar haemorrhage secondary to antineutrophil cytoplasmic antibody-positive vasculitis, presented to a district general hospital in the UK during the first wave of the global pandemic. This case highlights some of the difficulties clinicians may face when diagnosing life-threatening antineutrophil cytoplasmic antibody-positive vasculitis amidst the COVID-19 pandemic. The authors place emphasis on the careful interpretation of chemical biomarkers such as troponin and D-dimer when assessing patients with acute respiratory distress. They also aim to highlight the importance of CT thorax imaging when seeking an alternate diagnosis to COVID-19.

A Case of Diffuse Alveolar Hemorrhage With COVID-19 Vaccination

“…It directs toward a strong indication of cross-reaction between SARS-CoV-2 proteins and a variety of tissue antigens beyond just pulmonary tissue, which could lead to autoimmunity against connective tissue and the cardiovascular, gastrointestinal, and nervous systems [13]. This molecular mimicry could be associated with the development of autoimmune disease in the long term in COVID-19 infected patients or could occur after the vaccination too [14][15].…”

Severe pulmonary hemorrhage in a 3‐week‐old neonate with COVID‐19 infection: A case report

“…The gold standard is the sequential rise in red blood cells or hemosiderin‐laden macrophages on repeat BAL. 9 This invasive procedure was not done in our case for two main reasons. First, she was clinically unstable to perform bronchoscopy.…”

“…The literature suggests that hemoptysis is uncommon in COVID‐19 and has a symptom prevalence of 2%. 9 …”

“…Early bronchoalveolar lavage (BAL) is the diagnostic test needed to confirm diffuse alveolar hemorrhage. The gold standard is the sequential rise in red blood cells or hemosiderin‐laden macrophages on repeat BAL 9 . This invasive procedure was not done in our case for two main reasons.…”

“…The literature suggests that hemoptysis is uncommon in COVID-19 and has a symptom prevalence of 2%. 9 Regarding the etiology of pulmonary hemorrhage in patients with COVID-19, some case reports in adults suggested that patients with COVID-19 infection had increased inflammatory states that led to developing vasculitis and consequently pulmonary hemorrhage. 10 Autopsies performed on deceased adult patients revealed that pulmonary hemorrhage was interestingly associated with the inappropriate formation of thrombi.…”