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Article 20, 4/2016

CASE REPORT

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

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Alina Popp1,2,3, Ciprian Jurcuţ4, Daniel Vasile Balaban1, Mihai Șotcan4, Kaija Laurila3, Mariana Jinga1,4

1) Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2) Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania
3) Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
4) Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.cut

ABSTRACT
Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist.

Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed.

Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet.

Key words: alveolar hemorrhage – celiac disease – Lane-Hamilton syndrome.

Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu