Pulmonary Hemorrhage: Conclusion
Pulmonary hemorrhage has been described in association with a number of disorders, including necrotizing pulmonary infection, vasculitis, antibody-mediated disorders, and pulmonary infarction. Often, correction of the underlying disorder results in resolution of the pulmonary hemorrhage. Pulmonary hemorrhage is not commonly considered in the diagnosis of new pulmonary infiltrates in HIV-infected individuals, where the emphasis generally remains on evaluating and empirically treating for new infectious etiologies.
McKenzie and coworkers reviewed the causes of death in 75 HIV-infected individuals and describe only one case of pulmonary hemorrhage. Kahn and coworkers described 51 immunocompromised patients with severe pulmonary hemorrhage, of whom 3 patients had AIDS. Roland and coworkers identified AIDS as a risk factor for developing hemorrhage and speculated that the hemorrhage was attributed to pulmonary Kaposi’s sarcoma. Grebski and coworkers described alveolar hemorrhage in 2 of 38 patients with AIDS and pulmonary infiltrates, one patient with an unspecific interstitial pneumonia, and another with non-Hodgkin’s lymphoma. However, specific clinical details were not available in these reports. Click Here
We describe two HIV-infected patients who developed pulmonary infiltrates during the course of their hospitalization. In each case, BAL findings were consistent with pulmonary hemorrhage. Although the exact mechanism for pulmonary hemorrhage is not readily apparent, hemorrhage in these patients with AIDS appears to represent a complication of an underlying predisposition rather than an independent phenomenon or a new infectious process.
In both cases, a transient bleeding diathesis could account for the development of pulmonary hemorrhage. In case 1, pulmonary hemorrhage could be attributed to thrombocytopenia or to the platelet dysfunction of uremia. In case 2, pulmonary hemorrhage may have resulted from a transient coagulopathy secondary to disseminated intravascular coagulation, liver synthetic dysfunction, or antibiotics. Alternatively, the pulmonary hemorrhage may represent a complication of H capsulatum infection.
Category: Respiratory Symptoms
Tags: AIDS, alveolar hemorrhage, pulmonary infiltrates