The Drug-Induced Respiratory Disease Website
(Fr: hémorragie alvéolaire pure, isolée, sans auto-Ac). Diffuse bland alveolar hemorrhage (DAH). Can be severe or fatal (PMID 26236607). When unassociated with pulmonary vasculitis or capillaritis, the condition is named bland diffuse alveolar hemorrhage (DAH). Caution: hemosiderin-laden BAL macrophages can be found in DAD (PMID 19129275). Laboratory clues to this condition include ANA, ANCA, platelets and coagulation studies (INR, and full blood count). DAH may unravel thrombocytopenia (that may be drug-induced), coaculopathy, ANA- or ANCA- and, less often, anti-GBM-(drug)-related disease. Pulmonary capillaritis is more often suspected than proved, as the lung biopsy is generally avoided if typical gross BAL features for AH are present. ANCA of MPO-, HNE- or, less often, -PR3 with multispecificity and high titers suggest the drug etiology. Drug-induced DAH can mimic primary ANCA-related micropolyangiitis or 'Wegener's'. See PMID 19592204, 20442117, 21606695, 21674416. A search for underlying pulmonary condition at the origin of hemorrhage (e.g. lung cancer, bronchiectasis) is indicated. See also under IIIb, VId, Xs, Xz, XVIIv. 2018 review @PMID 30404115
Publications
Sirolimus-induced pulmonary hemorrhage of an infant with massive cervicofacial lymphatic malformation: A case report.
International journal of pediatric otorhinolaryngology 2023 Jan;164;111404 — 2023 Jan — 111404
Causes of Hemoptysis in Renal Transplant Patients.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 2018 Mar;16 Suppl 1;70-74 — 2018 Mar — 70-74
Kirby S, Satoskar A, Brodsky S, Pope-Harman A, Nunley D, Hitchcock C, Pelletier R, Ross P, Nadasdy T, Shilo K
Histological spectrum of pulmonary manifestations in kidney transplant recipients on sirolimus inclusive immunosuppressive regimens.
Diagnostic pathology 2012 Mar 14;7;25 — 2012 Mar 14 — 25
Fatal diffuse alveolar hemorrhage associated with sirolimus after allogeneic hematopoietic cell transplantation.
Bone marrow transplantation 2010 Aug;45;1363-4 — 2010 Aug — 1363-4
Severe respiratory failure due to diffuse alveolar hemorrhage: clinical characteristics and outcome of intensive care.
Journal of critical care 2010 Jun;25;230-5 — 2010 Jun — 230-5
Sirolimus-associated diffuse alveolar hemorrhage in a renal transplant recipient on long-term anticoagulation.
Clinical nephrology 2007 Oct;68;238-44 — 2007 Oct — 238-44
Sirolimus-induced alveolar hemorrhage.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2007 Jun;26;652-7 — 2007 Jun — 652-7
[Lung toxicity induced by rapamycin].
Revista portuguesa de pneumologia 2006 Nov-Dec;12;715-24 — 2006 Nov-Dec — 715-24
Brief communication: sirolimus-associated pneumonitis: 24 cases in renal transplant recipients.
Annals of internal medicine 2006 Apr 04;144;505-9 — 2006 Apr 04 — 505-9
Patterns of pulmonary complications associated with sirolimus.
Respiration; international review of thoracic diseases 2006;73;367-74 — 2006 — 367-74
Sirolimus-associated pulmonary toxicity.
Transplantation 2004 Apr 27;77;1215-20 — 2004 Apr 27 — 1215-20
Sirolimus-associated diffuse alveolar hemorrhage.
Mayo Clinic proceedings 2004 Apr;79;541-5 — 2004 Apr — 541-5
Characteristics of sirolimus-associated interstitial pneumonitis in renal transplant patients.
Transplantation 2001 Sep 15;72;787-90 — 2001 Sep 15 — 787-90