PMC7197000_01
Posteroanterior chest radiograph showing reticular micronodular opacities bilaterally in the first visit.
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Chest X-ray indicated bilateral interstitial reticular infiltrates (Figure 1).
(a) Posteroanterior chest radiography demonstrating bilateral pulmonary infiltrations at three months after first acute alveolar hemorrhage. (b) Axial CT scan of the thorax showing diffuse ground-glass appearance.
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Three months later, she was again admitted to the hospital for severe anemia with bilateral alveolar infiltrates on chest X-ray (Figure 2(a)). Repeated thoracic CT showed widespread ground-glass appearance throughout both lungs (Figure 2(b)).
(a) Hemosiderin-laden macrophage within gastric lavage fluid (hematoxylin and eosin stain). (b) Prussian blue stain of gastric lavage fluid.
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IPH was suspected from clinical manifestation and radiologic findings, and a diagnosis of IPH was confirmed by gastric lavage fluid that demonstrated the presence of hemosiderin-laden macrophages (Figures 3(a) and 3(b)). Intravenous prednisolone (2 mg/kg/day) and blood transfusion were given immediately for acute pulmonary bleeding, and promptly improved clinical symptoms and laboratory data.