Clinical Features and Treatment Strategy of
Vasculitis-Associated Diffuse Alveolar Hemorrhage

Ya-Chih Tien; Ying-Ming Chiu; Ming-Hui Hung; Jin-Lan Shen; Chih-Ming Lin

doi:10.26717/BJSTR.2018.11.002057

Research ArticleOpen Access

Clinical Features and Treatment Strategy of Vasculitis-Associated Diffuse Alveolar Hemorrhage

Volume 11 - Issue 1

**Hemorrhage Ya-Chih Tien¹, Ying-Ming Chiu^1,2, Ming-Hui Hung¹, Jin-Lan Shen¹, Chih-Ming Lin^3,4,5,**

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- ¹Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
- ²Department of Nursing, College of Nursing, HungKuang University, Taichung City, Taiwan.
- ³Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan.
- ⁴Department of Social Work and Child Welfare, Providence University, Taichung, Taiwan.
- ⁵Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan

Received: November 01, 2018; Published: November 16, 2018

DOI: 10.26717/BJSTR.2018.11.002057

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Abstract

Objectives: To summarize the clinical features and diagnostic approach of patients with vasculitis-associated diffuse alveolar hemorrhage (DAH). To investigate the optimal therapeutic strategy and highlight the effective corticosteroid dose and timing.

Methods: A retrospective chart review of the patients who were admitted to the intensive care unit (ICU) due to vasculitis-associated DAH was performed. Patient characteristics, clinical manifestations, the diagnosis of underlying etiology, treatment, and outcome were collected.

Results: During January 2015 to December 2017, seven vasculitis-associated DAH patients were reviewed. The mean age ± SD was 53.4 ± 18.2 years. Five patients (71%) were female. DAH was the initial presentation in all seven patients (100%). All patients required immediate mechanical ventilation. As first line therapy, methylprednisolone (MTP) pulse therapy combined with cyclophosphamide pulse therapy were administered to all patients. Six patients survived. Four of them received MTP and cyclophosphamide pulse therapy shortly after admission (mean 1.6 days, range: <1-3 days) showed good response to therapy and were extubated successfully within ten days after ICU admission.

Conclusion: Vasculitis-associated DAH is a fatal disorder. Once the diagnosis of DAH is confirmed, intensive administration of MTP and cyclophosphamide pulse therapy initiated within 3 days of admission provide good survival and pulmonary outcome.

Keywords : Alveolar hemorrhage; Corticosteroid; Lung Diseases; Therapeutic; Vasculitis

Abbreviations : DAH: Diffuse Alveolar Hemorrhage; ICU: Intensive Care Unit; MTP: Methylprednisolone; RBCs: Red Blood Cells; ANCA: Antineutrophil Cytoplasmic Antibody; AAV: Associated Vasculitis; BAL: Broncho-Alveolar Lavage; CXR: Chest X-Ray; SD: Standard Deviation; PTU: Propylthiouracil; CRP: C-Reactive Protein; ESR: Erythrocyte Sedimentation Rate; IVIG: Intravenous Immunoglobulin