Diffus的e alveolar hemorrhage in immunocompetent.pptVIP

Diffuse alveolar hemorrhage in immunocompetentpatients: Etiologies and prognosis revisited Respiratory Medicine (2012) 106, 1021e1032 Diffuse alveolar hemorrhage (DAH), commonly defined as the association of hemoptysis, new pulmonary infiltrates on chest x-ray and anemia, is a rare syndrome resulting from diffuse bleeding into the acinar portion of the lung. However, DAH can present in about 40% of the cases without hemoptysis. DAH is a diagnostic and therapeutic challenge because it may be revealed by nonspecific pulmonary manifestations and caused by multiple immune and non-immune disorders. Moreover, reported prognosis is poor, with in-hospital mortality ranging from 20 to over 50%. Prompt identification of the underlying cause of DAH and initiation of appropriate treatment is required in order to prevent acute respiratory failure. When DAH is a manifestation of systemic illness, early targeted treatment can also prevent the development of acute renal failure and the potential subsequent renal death. The standard regimen for remission induction of immune causes is based mainly on high-dose steroids. However, such treatment will be ineffective and potentially deleterious if the DAH is due to nonimmune causes, such as congestive heart failure or infection. Consequently, identification of the cause is crucial for adequate management of a patient with DAH. Over 100 causes of DAH have been reported in immunocompetent patients (Table 1 of the online supplement). Most of the published series focus primarily on immune causes, but numerous nonimmune causes of DAH have been reported as case reports. We recently showed that the global picture of DAH has changed over the last decades; nonimmune causes being largely underestimated. We also reported similar outcome for immune and non-immune causes. This finding challenged the belief that immune DAH exhibits a worse prognosis than non-immune DAH. Based on a retrospective cohort of 112 consecutive immunocompetent patients,