28202865 Visualization

The patient was a 48 Age - year Age - old Age man Sex who had previously been hospitalized Clinical_event due to hemoptysis Sign_symptom at Date 42 Date years Date of Date age Date .
At that time, a chest Biological_structure radiograph Diagnostic_procedure and chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) revealed diffuse Detailed_description ground Sign_symptom - glass Sign_symptom opacity Sign_symptom ( GGO Sign_symptom ) in the bilateral Biological_structure lung Biological_structure fields (Fig.1,2), and a bronchoscopic Diagnostic_procedure examination Diagnostic_procedure revealed the accumulation Sign_symptom of large Severity amounts Severity of blood Detailed_description in the trachea Biological_structure and bronchi Biological_structure (Fig.3).
The patient's bronchoalveolar Diagnostic_procedure lavage Diagnostic_procedure fluid Diagnostic_procedure ( BALF Diagnostic_procedure ) was bloody Lab_value and contained numerous hemosiderin Lab_value - laden Lab_value macrophages Lab_value .
A culture Diagnostic_procedure test Diagnostic_procedure of the BALF Diagnostic_procedure revealed no Lab_value findings Lab_value .
An electrocardiogram Diagnostic_procedure and transthoracic Biological_structure echocardiogram Diagnostic_procedure revealed no Lab_value abnormalities Lab_value .
A questionnaire Other_event that was completed at Date that Date time Date did not reveal the patient's hemorrhagic Sign_symptom episode Sign_symptom or a family history of bleeding disease, with the exception of his younger Family_history brother Family_history who Family_history had Family_history been Family_history diagnosed Family_history with Family_history hepatitis Disease_disorder C.
Furthermore, he had not received any drugs Medication that had the potential Detailed_description to Detailed_description cause Detailed_description DAH Detailed_description .
Following the above-mentioned examinations, DAH Disease_disorder due to some sort of vasculitis Disease_disorder was suspected.
Thus, treatment with high-dose intravenous Administration methylprednisolone Medication ( 1,000 Dosage mg Dosage daily Dosage ) for 3 Duration days Duration followed by prednisolone Medication ( 25 Dosage mg Dosage daily Dosage ) was initiated.
This relieved his symptoms Sign_symptom .
Chest Biological_structure CT Diagnostic_procedure showed the resolution of the GGO Sign_symptom .
The patient's prednisolone Medication dose was tapered Dosage and eventually discontinued Dosage at two Date - and Date - a Date - half Date years Date after his discharge Clinical_event from our hospital Nonbiological_location .
The patient was readmitted Clinical_event to our hospital Nonbiological_location with a recurrence of hemoptysis Sign_symptom at Date 46 Date years Date of Date age Date .
The above-described therapy was initiated and led to the improvement Lab_value of his condition Diagnostic_procedure .
The prednisolone Medication dose was tapered Dosage from 60 Dosage mg Dosage daily Dosage to a maintenance dose of 5 Dosage mg Dosage daily Dosage .
At Date 48 Date years Date of Date age Date , he was readmitted Clinical_event to our hospital Nonbiological_location with a further recurrence of hemoptysis Sign_symptom .
At this point, he had steroid Medication -induced diabetes Disease_disorder mellitus Disease_disorder , which was treated with glimepiride Medication ( 3 Dosage mg Dosage daily Dosage ).
At admission Clinical_event , his weight Diagnostic_procedure was 75 Lab_value kg Lab_value and height Diagnostic_procedure 167 Lab_value cm Lab_value ; his vital Diagnostic_procedure signs Diagnostic_procedure were as follows: blood Diagnostic_procedure pressure Diagnostic_procedure , 178/102 Lab_value mmHg Lab_value ; pulse Diagnostic_procedure rate Diagnostic_procedure , 109 Lab_value beats/min Lab_value , pulse Diagnostic_procedure oximetry Diagnostic_procedure , 97% Lab_value in room Detailed_description air Detailed_description ; and body Diagnostic_procedure temperature Diagnostic_procedure , 36.8°C Lab_value .
Chest Biological_structure auscultation Diagnostic_procedure revealed fine Detailed_description crackles Sign_symptom in the right Biological_structure lung Biological_structure field.
No skin Biological_structure rash Sign_symptom , subcutaneous Biological_structure bleeding Sign_symptom or joint Biological_structure swelling Sign_symptom were present.
A chest Biological_structure radiograph Diagnostic_procedure and CT Diagnostic_procedure showed the presence of diffuse Detailed_description GGO Sign_symptom in the bilateral Biological_structure lung Biological_structure fields.
Mild Severity anemia Sign_symptom was observed ( hemoglobin Diagnostic_procedure , 11.3 Lab_value g/dL Lab_value ), although hemoglobin Diagnostic_procedure levels had been 14.6 Lab_value g/dL Lab_value prior to the hemoptysis Sign_symptom episode.
The activated Diagnostic_procedure partial Diagnostic_procedure thromboplastin Diagnostic_procedure time Diagnostic_procedure ( APTT Diagnostic_procedure ) was prolonged Lab_value to 53.5 Lab_value seconds Lab_value (normal range, 25.1-40.7 seconds).
Laboratory Diagnostic_procedure tests Diagnostic_procedure showed that the patient's blood Diagnostic_procedure glucose Diagnostic_procedure and hemoglobin Diagnostic_procedure A1c Diagnostic_procedure levels were 299 Lab_value mg/dL Lab_value and 8.2% Lab_value , respectively, due to the steroid Medication -induced diabetes Disease_disorder mellitus Disease_disorder .
Autoantibodies Diagnostic_procedure for Diagnostic_procedure various Diagnostic_procedure collagen Diagnostic_procedure diseases Diagnostic_procedure were negative Lab_value (Table).
We diagnosed the condition as a recurrence of DAH Disease_disorder and again administered high Dosage - dose Dosage intravenous Administration methylprednisolone Medication for 3 Duration days Duration , followed by prednisolone Medication ( 60 Dosage mg Dosage daily Dosage ).
His condition Diagnostic_procedure improved Lab_value , as had been observed during the previous episodes.
A further detailed inquiry regarding the patient's medical history revealed that, as Date an Date elementary Date school Date student Date , he History had History been History hospitalized Clinical_event and had History received History blood History transfusions History twice History following History abnormally History heavy History bleeding Disease_disorder after History tooth History extraction History ; however, a specific congenital Detailed_description bleeding Disease_disorder disorder Disease_disorder had not been diagnosed at Date that Date time Date .
It was also revealed that his younger Family_history brother Family_history had Family_history been Family_history diagnosed Family_history with Family_history hemophilia Disease_disorder B Disease_disorder during Family_history adolescence Family_history .
Considering the possibility of hemophilia Disease_disorder , his blood Diagnostic_procedure coagulation Diagnostic_procedure factors Diagnostic_procedure were examined, revealing that his factor Diagnostic_procedure IX Diagnostic_procedure activity Diagnostic_procedure was 3% Lab_value .
The patient was subsequently diagnosed with moderate Severity hemophilia Disease_disorder B.
By the time of this diagnosis, the patient's DAH Disease_disorder had already resolved with the corticosteroid Medication therapy Medication .
We decided to continue treating the patient using prednisolone Medication alone, without coagulation Medication factor Medication IX Medication replacement Medication therapy Medication .
No recurrence of DAH Disease_disorder or hemorrhagic Sign_symptom symptoms Sign_symptom have been observed during Duration 3 Duration years Duration since the tapering and discontinuation of prednisolone Medication .