Diffuse alveolar haemorrhage and Libman-Sacks endocarditis: a rare presentation of antiphospholipid syndrome.
A 26-year-old woman with a history of idiopathic thrombocytopaenic purpura and a 1-year history of blood-streaked sputum presented after a severe episode of haemoptysis with dyspnoea. Chest imaging revealed diffuse ground glass and bronchovascular nodules. Bronchoscopy revealed bilateral diffuse alveolar haemorrhage (DAH). Sputum and bronchoalveolar lavage studies were negative for infectious aetiologies. A transthoracic echocardiogram revealed Libman-Sacks endocarditis with severe mitral regurgitation and physical examination revealed retinal artery occlusion and Osler's nodes. The patient had an increased anticardiolipin Immunoglobulin IgG and anti-B2 glycoprotein IgG, suggesting antiphospholipid syndrome (APLS). The patient was then started on high-dose methylprednisolone and had an improvement in her dyspnoea and haemoptysis. She was also started on anticoagulation as treatment for Libman-Sacks endocarditis. APLS should be considered as a possible underlying aetiology for unusual presentations of DAH with concurrent Libman-Sacks endocarditis in non-intravenous drug users with existing autoimmune disorders.
['Bielski|Brianna|B|', 'Shah|Nikhil H|NH|', 'Westerveld|Donevan|D|http://orcid.org/0000-0003-0906-7466', 'Stalvey|Carolyn|C|']
D000328:Adult D000893:Anti-Inflammatory Agents D017153:Antibodies, Anticardiolipin D016736:Antiphospholipid Syndrome D003937:Diagnosis, Differential D004417:Dyspnea D004452:Echocardiography D005260:Female D006469:Hemoptysis D006801:Humans D007074:Immunoglobulin G D008180:Lupus Erythematosus, Systemic D008775:Methylprednisolone D016553:Purpura, Thrombocytopenic, Idiopathic D016896:Treatment Outcome
haematology (incl blood transfusion) malignant and benign haematology respiratory medicine rheumatology valvar diseases