Primary amyloidosis causing diffuse alveolar hemorrhage.

ABSTRACT

Diffuse alveolar hemorrhage is a serious complication that has been described in various disease states including several vasculitic syndromes as well as conditions that may resemble vasculitis clinically. In this article, we present a case of 79-year-old man, who was admitted with productive cough, blood-tinged sputum, and a positive atypical antineutrophil cytoplasmic antibody pattern on indirect immunofluorescence microscopy. He subsequently developed frank hemoptysis and respiratory failure. Open lung biopsy demonstrated amyloid deposition within blood vessels. He was treated with 1 g of intravenous methylprednisolone over 3 days with rapid improvement in hemoptysis and hypoxemia. This case report and a review of literature illustrate unusual clinical manifestations of vascular amyloidosis that may be confused with vasculitis. Accurate diagnosis of this condition may improve clinical outcome and spare the patient from unwarranted, potentially harmful treatments.