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Introduction. Alveolar hemorrhage syndrome is a severe condition, with a high-risk of death. A timely diagnosis and therapy may be life-saving. The “gold-standard” method for diagnosing alveolar hemorrhage is bronchoscopy with bronchiolo-alveolar lavage. Pulmonary function tests are useful to appreciate the severity of alveolar hemorrhage. The objective of the study was to measure the impact of alveolar hemorrhage on lung function tests and to detect useful associations between Golde score value and the type of alveolitis with spirometry tests, lung diffusing capacity for carbon monoxide (DLCO) and carbon monoxide transfer coefficient (KCOc), and six minutes walking test (6MWT). Material and methods. We conducted a retrospective study on a sample of 60 patients diagnosed with alveolar hemorrhage syndrome, hospitalized in The National Institute of Pneumology “Marius Nasta” Bucharest, Romania, between June 2010 and February 2019. Results. The results of bronchiolo-alveolar lavage show that macrophage alveolitis is associated with moderate-severe alveolar hemorrhage syndrome, while neutrophilic and lymphocytic alveolitis are associated with mild to moderate alveolar hemorrhage syndrome. Pulmonary function tests (spirometry and complex respiratory tests) showed that only Tiffeneau index, maximal expiratory flow at 50% of vital flow capacity and DLCOc were influenced by the presence of moderate to severe alveolar hemorrhage. The degree of desaturation measured at the end of 6MWT did not correlate with the degree of alveolar hemorrhage severity. Conclusions. An abnormal gas transfer is common in alveolar hemorrhage, an increase of DLCOc value being a sensitive marker for the disease.

Résumé L’hémorragie intra-alvéolaire (HIA) est une maladie rare et grave. Le diagnostic est évoqué devant la triade hémoptysie, anémie et infiltrat radiologique. Il est confirmé par la réalisation d’une tomodensitométrie thoracique et d’une fibroscopie bronchique avec lavage broncho-alvéolaire révélant des sécrétions uniformément hémorragiques. Les étiologies en sont nombreuses. Elles sont classiquement différenciées en cause « immune » (vascularites liées aux anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA), les connectivites/lupus érythémateux systémique (LES) et le syndrome de Goodpasture) et « non immune » (cardiopathie, toxique, infection…). Un bilan étiologique avec la recherche de signes cliniques extrathoraciques, d’auto-anticorps (anticorps anti-nucléaires et anti-membrane basale glomérulaire [ANCA]), la réalisation d’une échographie cardiaque et la recherche d’une imputabilité iatrogénique ou d’un contexte septique évident est urgent. Le LES et le syndrome des antiphopholipides sont les causes immunes les plus fréquentes en rhumatologie avec les vascularites à ANCA. Les autres connectivites sont rarement directement impliquées dans le mécanisme d’HIA, hormis en cas de formes associées à une vascularite et la présence d’ANCA. Une telle situation doit donc faire rechercher une cause « non immune » en priorité. Alveolar hemorrhage (AH) is a rare and serious disease. Diagnosis is suspected with the three following symptoms: hemoptysis, anemia and radiological infiltrate. It is confirmed by performing a thoracic CT scan and bronchoscopy with bronchoalveolar lavage revealing uniformly hemorrhagic secretions. Etiologies are numerous. They are classically differentiated into “immune” causes (vasculitis related to anti-cytoplasmic neutrophil antibodies (ANCA), connective tissue diseases/systemic lupus erythematous (SLE) and Goodpasture's syndrome) and “non-immune” causes (heart disease, toxic, infection…). Etiological assessment with the search for extrathoracic clinical signs, dosage of autoantibodies (ANCA, anti-nuclear antibodies and anti-glomerular basement membrane), the realization of a cardiac ultrasound, elimination of a iatrogenic cause or an obvious septic condition is urgent. SLE and antiphopholipid syndrome are the most common immune causes in rheumatology with ANCA-related vasculitis. Other connective tissue diseases are rarely directly involved in the AH mechanism, except in cases of vasculitis-associated forms and the presence of ANCA. In such a situation, a “non-immune” cause must be sought in priority. [ABSTRACT FROM AUTHOR]

Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up., (Copyright © 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Résumé Introduction Les injections de produits siliconés, en particulier illégales à visée esthétiques, peuvent être responsables de complications sévères notamment systémiques parmi lesquelles le syndrome d’embolie siliconée. Observation Nous rapportons le cas d’un patient de 39 ans ayant présenté une détresse respiratoire aiguë sévère en rapport avec une hémorragie intra-alvéolaire associée à une ulcération chronique de la base de la verge et à un lymphœdème génital. Le tableau était celui de complications d’injections répétées de silicone et révélait un trouble de la personnalité. Le diagnostic de syndrome d’embolie siliconée a été posé, quelques années après, sur l’examen histologique de l’ulcération persistante du pénis. L’évolution a été favorable. Conclusion Un tableau d’hémorragie intra-alvéolaire grave chez un patient jeune doit faire évoquer un syndrome d’embolie siliconée, notamment s’il existe des lésions cutanées compatibles avec des injections. Introduction Silicone injections, in particular illegal injections, carried out in an aesthetic purpose, can cause serious complications, like silicone embolism syndrome. Case report We present a 39-year-old man who presented with a severe acute respiratory distress syndrome related to an alveolar hemorrhage associated with a persistent penis ulcer and a genital lymphedema. It was the complications of silicone injections which revealed a severe personality disorder. Diagnosis of silicone embolism syndrome was made, a few years later, thanks to the histopathology study of a persistent penis ulcer with genital lymphedema. The outcome was favorable. Conclusion A serious alveolar hemorrhage in a young patient should raise suspicion of silicone embolism syndrome, especially if there are cutaneous lesions compatible with injections. [ABSTRACT FROM AUTHOR]

Abstract: Diffuse alveolar hemorrhage (DAH) is defined by the presence of red blood cells originating from the lung capillaries or venules within the alveoli. The diagnosis is established on clinical features, radiological pattern, and especially bronchoalveolar lavage. Diffuse alveolar hemorrhage may have many immune or non-immune causes. Immune causes of DAH include vasculitides, connective tissue diseases, especially systemic lupus erythematosus, and antiglomerular basement membrane antibody disease (Goodpasture''s syndrome). Treatment is both supportive and causal, often based on high dose corticosteroids and immunosuppressive therapy (especially intravenous cyclophosphamide). Plasma exchanges are performed in antiglomerular basement membrane antibody disease and systemic lupus erythematosus, and are considered in systemic vasculitis. Non-immune causes of DAH mainly include heart diseases, coagulation disorders, infections, drug toxicities and idiopathic DAH. Treatment of non-immune DAH is that of its cause. Whatever the cause, DAH is an emergency requiring prompt assessment and early treatment. [Copyright &y& Elsevier]

Abstract: Introduction: Giant cell arteritis (GCA) is a granulomatous vasculitis of the large and medium size vessels with a remarkable sensitivity to corticosteroids, although it may be dependent to therapy. In rare cases, a vasculitis of the medium or small-size vessels may mimic, be associated to, or follow GCA. We report a case of GCA dependent to corticosteroids that was followed five years after diagnosis by an alveolar hemorrhage leading to the diagnosis of a possible Wegener''s granulomatosis. Exegesis: A 70-year-old man had a diagnosis of GCA fulfilling the ACR criteria in 1999. Temporal artery biopsy revealed a typical histological pattern. The initial response to corticosteroids was excellent, but the patient became dependent to corticosteroids, so he was given methotrexate from 2002. Severe alveolar haemorrhage occurred in December 2004, leading to the diagnosis of possible ANCA positive, anti-proteinase 3 positive Wegener''s granulomatosis. Conclusion: ANCA-positive vasculitis may complicate the course of GCA. This evolution should be rapidly recognized, because its treatment differs to that of GCA. [Copyright &y& Elsevier]

In France, cocaine is the second most commonly illicit drug used after cannabis. Cocaine, mainly smoked in the form of crack, can be responsible for a wide range of respiratory disorders. The aim of this systematic literature review was to clarify what is known about the link between cocaine use and alveolar hemorrhage. We performed a Medline search covering the period 1980-2016 and collected data from 84 articles. The number of acute forms described in the literature is small but postmortem studies show that hidden forms are frequent. The diagnosis is based on the association of hemoptysis, anemia and diffuse alveolar opacity. Bronchoalveolar lavage shows hemosiderin-laden macrophages. Of the 13 cases identified, 12 patients had hemoptysis, anemia and diffuse alveolar infiltration on pulmonary or chest CT. In 9 cases, the presence of hemosiderin-laden macrophages was identified in bronchoalveolar lavage or pulmonary biopsy. Except for 2 deaths, the outcome was favorable when cocaine use was stopped. Systematic interventions to help people stopping using this psychoactive substance will protect lung health., (Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Silicone injections, in particular illegal injections, carried out in an aesthetic purpose, can cause serious complications, like silicone embolism syndrome., Case Report: We present a 39-year-old man who presented with a severe acute respiratory distress syndrome related to an alveolar hemorrhage associated with a persistent penis ulcer and a genital lymphedema. It was the complications of silicone injections which revealed a severe personality disorder. Diagnosis of silicone embolism syndrome was made, a few years later, thanks to the histopathology study of a persistent penis ulcer with genital lymphedema. The outcome was favorable., Conclusion: A serious alveolar hemorrhage in a young patient should raise suspicion of silicone embolism syndrome, especially if there are cutaneous lesions compatible with injections., (Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)