A case of recurrent hemoptysis presenting with hypoxia and pulmonary infiltrates

Diffuse Alveolar Haemorrhage had been one of the most misdiagnosed and under rated causes of hemoptysis leading to mis management in many cases. Many causes of Diffuse Alveolar Haemorrhage arises from Vasculitis and therefore are treatable and controllable. Here we got a Female Child of 13 years from Rural area who had been suffering since 6 years of her age from the hemoptysis and hypoxia and admitted thrice for the same. The initial management were symptomatic and even 1 course of Antitubercular drug. But this patient when presented to us with the triad of Hemoptysis Hypoxia decreased hematocrit and we found a diffuse alveolar Haemorrhage on the HRCT thorax, we instantly evaluated her for cause. The ANCA MPO title was significantly raised and BAL from FOB showed serially increasing hematocrit with multiple hemosiderin laden macrophages. Thus a Diagnosis of DAH due to Microscopic Polyangitis was made. Microscopic polyangitis although occurs in young adults may very rarely be found in children of teen age groups. The early starting of steroids like in this patient would probably prevent future renal involvement as well which is much more dreaded.