CHEST Guidelines-Two-Immunocompromised-Patients-With-Diffuse-Alveol

Two-Immunocompromised-Patients-With-Diffuse-Alveol

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The document discusses two cases of immunocompromised patients who developed diffuse alveolar hemorrhage (DAH) as a complication of severe COVID-19. DAH is a serious condition characterized by bleeding into the alveoli, the tiny air sacs in the lungs, and is typically associated with autoimmune diseases and pulmonary infections.<br /><br />The first patient, a 79-year-old man with a history of autoimmune aortitis, high-grade urothelial carcinoma, and various chronic conditions, presented with hypoxemic respiratory failure and hemoptysis after COVID-19 infection. Despite supportive measures, his condition deteriorated rapidly, and he passed away without invasive mechanical ventilation due to a palliative care decision.<br /><br />The second patient, a 70-year-old man, initially presented with idiopathic hypereosinophilic syndrome, characterized by excessively high eosinophil counts and various organ involvements. After exposure to the first patient, he developed severe respiratory symptoms and DAH, which was confirmed by bronchoscopy and testing positive for SARS-CoV-2. With supportive treatment, including glucocorticoids, he gradually recovered.<br /><br />These cases highlight that DAH can be a complication of COVID-19, especially in immunocompromised individuals. The document notes that hemoptysis is a rare COVID-19 symptom but emphasizes the need to consider DAH as a potential complication in severe cases. The authors suggest that DAH might be underrecognized in COVID-19 due to limited bronchoscopy use. They argue that healthcare providers should be attentive to this complication, especially given the varying severity of COVID-19 and the increased risk factors such as age, comorbidities, and immunosuppression.

Keywords

immunocompromised patients

diffuse alveolar hemorrhage

COVID-19 complication

autoimmune diseases

pulmonary infections

hemoptysis

hypoxemic respiratory failure

glucocorticoids treatment

bronchoscopy

SARS-CoV-2