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Introduction <p>Diffuse alveolar hemorrhage (DAH) is a potentially fatal pulmonary condition caused by bleeding into the alveolar spaces due to disruption of the alveolar–capillary membrane. Although DAH is well recognized in antineutrophil cytoplasmic antibody–associated vasculitis and anti–glomerular basement membrane disease, its association with IgA nephropathy is extremely rare. Occurrence of DAH after progression of IgA nephropathy to dialysis-dependent end-stage renal disease (ESRD) is even more uncommon.</p> Case Presentation <p>We report a 35-year-old man with biopsy-proven IgA nephropathy who had progressed to ESRD and was receiving maintenance hemodialysis. He presented with hemoptysis, progressive dyspnea, and a decline in hemoglobin levels. Imaging revealed bilateral ground-glass opacities. Flexible bronchoscopy with bronchoalveolar lavage demonstrated sequentially hemorrhagic aliquots with hemosiderin-laden alveolar macrophages, confirming diffuse alveolar hemorrhage. Infectious workup, coagulation disorders and autoimmune serology were negative. The patient was treated with pulse methylprednisolone followed by oral corticosteroids, resulting in rapid clinical and radiological improvement.</p> Conclusion <p>This case highlights that systemic IgA-mediated vasculitic activity may persist despite dialysis-dependent end stage renal failure. Clinicians should consider DAH in dialysis patients presenting with hemoptysis, anemia, and new pulmonary infiltrates, as early recognition and timely immunosuppressive therapy can be lifesaving.</p>

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Diffuse Alveolar Hemorrhage in Dialysis-Dependent IgA Nephropathy Suggesting Persistent Systemic Vasculitis: A Case Report and Literature Review

  • 期刊论文

  • 发表日期：

    2026年5月7日

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  • Neeraj Sharma,
  • Vijoy Kumar Jha,
  • Sanjay Kumar Panda,
  • Dongare Ninad S,
  • Robin Choudhary,
  • Shibu Sasidharan

摘要

Introduction

Diffuse alveolar hemorrhage (DAH) is a potentially fatal pulmonary condition caused by bleeding into the alveolar spaces due to disruption of the alveolar–capillary membrane. Although DAH is well recognized in antineutrophil cytoplasmic antibody–associated vasculitis and anti–glomerular basement membrane disease, its association with IgA nephropathy is extremely rare. Occurrence of DAH after progression of IgA nephropathy to dialysis-dependent end-stage renal disease (ESRD) is even more uncommon.

Case Presentation

We report a 35-year-old man with biopsy-proven IgA nephropathy who had progressed to ESRD and was receiving maintenance hemodialysis. He presented with hemoptysis, progressive dyspnea, and a decline in hemoglobin levels. Imaging revealed bilateral ground-glass opacities. Flexible bronchoscopy with bronchoalveolar lavage demonstrated sequentially hemorrhagic aliquots with hemosiderin-laden alveolar macrophages, confirming diffuse alveolar hemorrhage. Infectious workup, coagulation disorders and autoimmune serology were negative. The patient was treated with pulse methylprednisolone followed by oral corticosteroids, resulting in rapid clinical and radiological improvement.

Conclusion

This case highlights that systemic IgA-mediated vasculitic activity may persist despite dialysis-dependent end stage renal failure. Clinicians should consider DAH in dialysis patients presenting with hemoptysis, anemia, and new pulmonary infiltrates, as early recognition and timely immunosuppressive therapy can be lifesaving.