Diffuse alveolar hemorrhage

Etiologies

• Pathologic capillaritis (most common), caused by pulmonary inflammation
  • Primary small-vessel vasculitis: GPA, EGPA, MPA, isolated pauci-immune pulmonary capillaritis, idiopathic pauci-immune glomerulonephritis
  • Primary immune complex-mediated vasculitis: Goodpasture syndrome, Henoch-Schönlein purpura
  • Secondary vasculitis: SLE, RA, antiphospholipid antibody syndrome, mixed connective tissue disease, polymyositis, dermatomyositis
  • Essential cryoglobulinemia
  • Behcet disease
  • Acute lung transplantation rejection
  • Autologous bone marrow transplantation
  • Drug-induced, including chemotherapy, propylthiouracil
• No pathologic capillaritis (i.e. bland pulmonary hemorrhage, RBC leak without damage to the capillaries)
  • Idiopathic pulmonary hemosiderosis
  • Coagulopathy, including anticoagulants, antiplatelets, thrombolytics, DIC
  • Mitral stenosis and pulmonary veno-occlusive disease
  • Inhalational injury, including isocyanates, crack cocaine, retinoic acid
  • Goodpasture syndrome
  • SLE
  • Drug-induced, including amiodarone, penicillamine, nitrofurantoin
• Diffuse alveolar damage
  • Bone marrow transplantation
  • Inhalation
  • Cytotoxic drug therapy
  • Radiation therapy
  • ARDS
  • Infection
  • Malignancy
  • Embolism

Infections

• Immunocompromised: CMV, adenovirus, invasive aspergillosis, Mycoplasma, Legionella, Strongyloides
• Immunocompetent: influenza A, dengue, leptospirosis, malaria, Staphylococcus aureus pneumonia
  • Also: CMV, hantavirus pulmonary syndrome