A patient with acute hypoxemic respiratory failure and diffuse alveolar hemorrhage syndrome

We report here the case of a 32-year-old male who went to the Emergency Ward of the Sant’Agata of Militello Hospital (in the province of Messina, Italy) for the presence in the last 5 days of exertion dyspnea and hemoptysis. An arterial blood gas analysis performed in oxygen therapy [fractional concentration of oxygen (O2) in inspired gas % (FiO2) unknown] showed the presence of acute hypoxemic respiratory failure. An x-ray and computed tomography (CT) of the chest (without intravenous contrast) showed the presence of diffuse and bilateral pulmonary opacities with a ground glass appearance. The patient was transferred to our Pulmonology Clinic. His past medical history was unremarkable. Laboratory tests showed neutrophilia, microcytic hypochromic anemia and a slight increase of the serum C reactive protein level.During his hospital stay we performed a careful differential diagnostic approach to diffuse alveolar hemorrhage syndrome without being able to identify a cause. The lung function tests showed the presence of normal lung volumes and an increase of the diffusing capacity for carbon monoxide. The patient was treated with oxygen therapy, antibiotics, systemic glucocorticoids and red blood cells transfusions and discharged at home with resolution of the clinical, functional and radiological features. Conclusions We discuss here an unusual cause of acute hypoxemic respiratory failure secondary to idiopathic diffuse alveolar hemorrhage syndrome.