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  • Rare cause of diffuse alveolar haemorrhage and subconjunctival haemorrhage rescued by extracorporeal membrane oxygenation and rituximab

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Case Reports: Rare disease
Rare cause of diffuse alveolar haemorrhage and subconjunctival haemorrhage rescued by extracorporeal membrane oxygenation and rituximab
  1. Zaiying Hu,
  2. Xiaoxue Feng,
  3. Baiyu Zhang and
  4. Jianlin Huang
  1. Department of Rheumatology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
  1. Correspondence to Dr Zaiying Hu; huzying{at}mail.sysu.edu.cn

Abstract

A previously healthy man in his 20s presented with acute respiratory distress syndrome and subconjunctival haemorrhage. Imaging was indicative of pervasive pulmonary haemorrhage. There was no evidence of renal involvement. The patient rapidly deteriorated with aggravating respiratory failure regardless of invasive mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This maintained the patient adequate time to allow aggressive therapy. Skin biopsy indicated leucocytoclastic vasculitis. Given that the patient was C-antinuclear cytoplasmic autoantibody (ANCA) positive, pulse dose steroids and rituximab were initiated for the suspicion of ANCA-associated vasculitis (AAV) which resulted in improvement of airspace disease and subconjunctival haemorrhage. Only a few cases reported successful use of ECMO in severe diffuse alveolar haemorrhage (DAH) due to AAV, but no case was in DAH combined with subconjunctival haemorrhage. The need for systemic anticoagulation with pre-existing haemorrhage is still a challenging dilemma.

  • Respiratory system
  • Immunology
  • Adult intensive care
  • Vasculitis
  • Mechanical ventilation

https://doi.org/10.1136/bcr-2022-250025

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    Footnotes

    • Contributors ZH and XF wrote the article. BZ did the literature search. JH was responsible for the acquisition, analysis and interpretation of important data for the work. ZH contributed to the conception and design of the work and revised it critically for important intellectual content. All authors approved the current version and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.