Objective Patients with scleroderma associated interstitial lung disease (SSc-ILD) are at an increased risk for lung cancer, necessitating a high index of suspicion for timely detection. This case series describes three patients with SSc-ILD who developed lung cancer, highlighting diagnostic and therapeutic challenges in detecting and managing malignancy within abnormal lung parenchyma. Methods Electronic medical records were reviewed by a team of physicians. Clinical, radiographic, and pathologic data from each patient’s disease course were synthesized to illustrate diagnostic workup and management decisions. Results The series includes two former smokers with minimal smoking history and one never-smoker. Lung cancer stages at diagnosis ranged from IA to IVb. Positron emission tomography imaging was instrumental in raising suspicion for malignancy and selecting diagnostic sites. Pausing immunosuppression led to ILD progression for all patients. Conclusion This case series emphasizes the importance of maintaining a high index of suspicion for lung cancer in patients with SSc-ILD, including among minimal or non-smokers, and highlights the urgent need for future research into risk factors and mechanistic pathways, screening strategies, and management approaches for lung cancer in SSc-ILD.
Humidifier lung is a rare phenotype of hypersensitivity pneumonitis caused by inhalation of aerosolized antigens from contaminated humidifiers, and identification of the causative antigen is often challenging. We report a case of humidifier lung in a 63-year-old woman who presented with recurrent episodes of fever, cough, and dyspnea. Chest computed tomography showed diffuse ground-glass opacities with mosaic attenuation, and bronchoalveolar lavage fluid revealed lymphocytosis. Her symptoms improved without treatment during hospitalization but recurred 5 hours after returning home, suggesting re-exposure to an environmental antigen.A humidifier challenge test reproduced symptoms, including fever, cough, and hypoxemia, necessitating systemic corticosteroid therapy. Fungal contamination was identified within the internal components of the humidifier, from which Purpureocillium lilacinum was isolated. A serum precipitin test using an antigen prepared from the isolate showed a positive reaction. Although precipitin testing with a routine antigen panel showed positivity for multiple antigens, possible cross-reactivity was considered.Taken together, these findings led to the diagnosis of humidifier lung, with Purpureocillium lilacinum considered the most likely causative antigen. This case highlights the importance of integrating the clinical course, environmental assessment, and provocation testing in identifying causative antigens in humidifier lung.
Herein, we report the case of an 87-year-old woman who presented with acute chest pain, fever, and cough. Imaging revealed a right pneumothorax, pleural effusion, and bronchiectasis. Pleural fluid was exudative with elevated adenosine deaminase levels, and Mycobacterium avium complex (MAC) was confirmed. Thoracoscopic plication and empyema cavity curettage were performed. Postoperatively, clarithromycin, rifampicin, ethambutol, and amikacin were initiated, leading to clinical improvement, smear and culture negativity, and discharge. Pleuritis caused by nontuberculous mycobacteria (NTM) is rare, occurring in only 1.4% of patients with NTM pulmonary disease; however, pneumothorax has been reported in 41% of these patients. NTM pleural disease with empyema is associated with a poor prognosis, with a 1-year mortality rate of 14-37%. In our report, early diagnosis enabled timely surgical and pharmacological intervention. This report highlights that even in advanced-age patients with preserved performance status, early multidisciplinary management may achieve favorable outcomes in MAC-associated pneumothorax and pleuritis.
Background Dynamic left ventricular outflow tract obstruction (LVOTO) is a recognized complication of stress cardiomyopathy and can mimic hypertrophic obstructive cardiomyopathy (HOCM) even in the absence of structural hypertrophy. In critically ill patients with severe pulmonary disease, preload, afterload, and contractility can be altered which may exacerbate obstruction. Case Presentation A 76-year-old woman with interstitial lung disease and microscopic polyangiitis receiving immunosuppressive therapy presented with progressive dyspnea and shock. Transthoracic echocardiography demonstrated systolic anterior motion (SAM) of the mitral valve and a dynamic LVOT gradient which increased with Valsalva maneuver. Coronary angiography showed no obstructive coronary artery disease. Cardiac magnetic resonance imaging demonstrated normal left ventricular wall thickness with hypokinesis of the mid-to-apical segments suggestive of stress cardiomyopathy. Her clinical course was complicated by COVID-19 pneumonia, recurrent shock, mechanical ventilation, and progressive right ventricular dysfunction. Repeat echocardiography demonstrated persistent dynamic obstructive physiology despite the absence of structural cardiac disease. Treatment required careful preload optimization, vasopressor selection, and respiratory support, as interventions commonly used for shock and pulmonary edema risked worsening LVOTO. Conclusion This case highlights stress cardiomyopathy complicated by dynamic LVOTO presenting with pseudo-HOCM physiology. Clinical complications of severe pulmonary disease, respiratory failure, and right ventricular dysfunction likely amplified the preload-dependent obstruction and contributed to refractory hemodynamic instability. Due to standard shock therapies paradoxically worsening obstruction, early echocardiographic recognition and physiology-guided management are critical in this population.
Background Diesel Siphoner's Lung is a severe, life-threatening subtype of acute exogenous lipoid pneumonia (ELP) caused by accidental diesel fuel aspiration. While diagnosis is typically straightforward with a clear exposure history, clinical management is challenging due to rapidly progressive respiratory failure. Given the relative rarity of such accidents and the lack of standardized management guidelines, optimizing therapeutic strategies remains a significant clinical challenge. Case presentation We report two cases of acute ELP resulting from diesel siphoning—a distinct clinical entity termed 'Diesel Siphoner's Lung'—demonstrating highly divergent clinical trajectories. Case 1, a previously healthy 48-year-old male, presented with acute lung injury (ALI) 8 hours post-aspiration. Prompt interventions, including endotracheal intubation, serial segmental bronchoalveolar lavage (sBAL) and systemic corticosteroid therapy, were adopted. Following progressive clinical improvement, the patient was extubated on the 8th day and subsequently discharged on the 25th day with substantial radiological resolution. Conversely, Case 2—a 45-year-old male with a history of diabetes and hypertension—was admitted with established acute respiratory distress syndrome (ARDS) 2 days post-aspiration. His clinical course was severely complicated by multidrug-resistant nosocomial infections and a left-sided hydropneumothorax, refractory to similar clinical management with endotracheal intubation, serial sBAL, and systemic corticosteroid therapy. Despite the initiation of extracorporeal membrane oxygenation (ECMO) rescue therapy on the 11th day, the patient ultimately succumbed to multiple organ failure on the 19th day. Conclusion The divergent outcomes of our two reported cases, coupled with findings from the relevant literature, highlight the critical necessity of an multimodal intervention strategy. We advocate for the prompt implementation of sBAL to mechanically remove aspirated lipids and halt ongoing chemical cytotoxicity, combined with early systemic corticosteroid therapy to attenuate the fulminant inflammatory cascade. Furthermore, in severe cases presenting with refractory hypoxemia and irreversible pulmonary damage, ECMO should be recognized as a viable and crucial bridge to subsequent lung transplantation.
Vanazacaftor-Tezacaftor-Deutivacaftor (VTD) is a novel cystic fibrosis transmembrane receptor (CFTR) modulator therapy. This development added another highly effective modulator therapy to the market as an alternative to the standard of care, Elexacaftor-Tezacaftor-Ivacaftor (ETI). Phase III trial data comparing VTD and ETI demonstrated non-inferiority in outcomes and similar adverse effect profile and rates. Here we present a case series demonstrating known and potentially unknown side effects, specific to VTD. From January 2025 to June 2025, 38 out of 400 patients at our adult CF center, were switched from ETI to VTD. Six of those patients experienced potential VTD related adverse events. Liver function testing (LFT) elevations were seen in 2/6 cases, worsening pulmonary symptoms in 3/6 cases, dermatologic manifestations in 2/6 cases, hypertension in 1/6 cases, neuropsychiatric symptoms in 2/6 cases, and gastrointestinal symptoms in 2/6 cases. Notably, one case led to hospitalization, with development of a severe rash, thrombocytopenia, and LFT elevations. In each case, all symptoms and laboratory manifestations resolved within days after switching back to ETI. This case series demonstrates both previously recognized and unrecognized adverse effects of VTD in a “real-world population.” The majority of our patients’ presenting symptoms were described in phase III clinical trials, including LFT elevations, pulmonary exacerbations, rash, and neuropsychiatric symptoms. On the contrary, thrombocytopenia, gastrointestinal manifestations, and hypertension have not been described thus far with VTD. Further research and more robust monitoring are needed to determine the overall incidence and risk of lesser-known side effects of novel CFTR modulators.
Introduction Persistent air leak (PAL) secondary to bronchopleural fistula (BPF) is a serious complication of secondary spontaneous pneumothorax (SSP) resulting from ruptured emphysematous bullae in patients with chronic obstructive pulmonary disease (COPD). Management is particularly challenging in elderly high-risk individuals who are unsuitable for surgical intervention. Fresh frozen plasma (FFP), containing fibrinogen and coagulation factors, may act as a biological sealant and facilitate pleural closure. Case report A 76-year-old man, a former smoker with COPD and multiple comorbidities presented with severe acute dyspnea and persistent cough due to right-sided pneumothorax with lung collapse. A water-sealed intercostal chest drain was inserted; although respiratory distress improved, a persistent air leak continued. High-resolution computed tomography confirmed right-sided pneumothorax with associated lung atelectasis and multiple emphysematous bullae. Given the high surgical risk, a total of three units of ABO-compatible fresh frozen plasma (FFP) were administered intrapleurally through the existing chest tube on alternate days. A gradual reduction in air leak was observed, with complete cessation by day 17. The chest tube was removed on day 20 following radiographic confirmation of full lung re-expansion. At 6-month follow-up, the patient remained clinically stable without recurrence of pneumothorax or the need for further pleural intervention. Conclusion Intrapleural FFP pleurodesis may represent a safe, feasible, and cost-effective alternative for managing persistent air leak in high-risk elderly COPD patients when surgical options are contraindicated. Complete resolution may require a prolonged course; however, the favorable outcome without complications reinforces the value of a carefully selected management strategy in this challenging clinical context.
Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, induces near-complete eosinophil depletion and provides substantial benefit in severe eosinophilic asthma. We report an 80-year-old woman with severe eosinophilic asthma who was treated with benralizumab from August 2020. Peripheral blood eosinophils rapidly decreased to 0/μL, asthma exacerbations ceased, and lung function improved. Over the subsequent four years, while asthma remained well controlled, she developed a temporally ordered sequence of clinical events, including elderly-onset seronegative rheumatoid arthritis, biopsy-proven erythema nodosum, a radiologically characteristic pulmonary hamartoma, and early-stage hormone receptor-positive breast cancer. Erythema nodosum resolved completely after mastectomy without changes in immunosuppressive therapy, suggesting a possible paraneoplastic association. Among these events, inflammatory arthritis may represent the most biologically plausible finding potentially associated with prolonged eosinophil depletion, whereas the remaining findings are more appropriately interpreted descriptively and in the context of alternative explanations, including aging, background disease incidence, and coincidence. This case describes a rare temporal association in a single patient and does not establish causality. Rather than challenging the established favorable safety profile of benralizumab, it highlights the importance of careful long-term clinical follow-up and attention to newly emerging systemic manifestations during eosinophil-depleting biologic therapy, particularly in older adults.
Background Pulmonary Alveolar Microlithiasis (PAM) is an extremely rare, progressive, and irreversible lung disease characterized by diffuse deposition of calcium phosphate microliths in alveoli. Most cases present with nonspecific symptoms or are asymptomatic, making diagnosis challenging. Methods We present the case of a 32-year-old male carpenter who was a 15-year smoking and drinking history and admitted due to bilateral lung lesions detected during physical examination, accompanied by intermittent chest tightness, cough and expectoration. Report the clinical manifestations, imaging findings, and analysis of SLC34A2 gene amplification and sequencing results to elucidate the mutation phenotype in this case. Results Chest CT showed "blizzard-like" diffuse calcified nodules, and genetic testing identified a novel homozygous frameshift deletion mutation c.1903delG (p.C635Afs*34) in exon 13 of the SLC34A2 gene. The diagnosis was highly suggestive of PAM. Conclusion This case presents a novel pathogenic mutation of SLC34A2 not previously reported, enriching the mutation spectrum of PAM. The high resolution CT combined with genetic testing is emphasized in the diagnosis of PAM.
Symptomatic pulmonary aspergilloma and chronic cavitary pulmonary aspergillosis (CCPA) are typically managed with surgical resection or prolonged triazole therapy, but many patients are poor surgical candidates, and many cannot tolerate voriconazole. Our centre has previously described bronchoscopic debridement combined with antifungal therapy as a minimally invasive alternative for patients with accessible intracavitary fungal balls. Isavuconazole, a newer triazole with a more favourable adverse-event and drug-drug interaction profile, has not been well characterised in this setting. We performed a retrospective single-centre review of nine adults with pulmonary aspergilloma or CCPA referred to our interventional pulmonology service who received isavuconazole between September 2022 and September 2025. Of these, six underwent attempted bronchoscopic debridement (four successful, two with limited or unsuccessful access), one required surgical resection after bronchoscopy failed, one was managed medically because the cavity was inaccessible, and one declined further procedure. Three patients had previously received voriconazole; two were switched to isavuconazole because of intolerance and one was re-treated with isavuconazole at recurrence. One patient developed isavuconazole-associated drug-induced liver injury requiring discontinuation. Three patients died during follow-up: two from causes unrelated to aspergillosis (acute coronary event during dialysis; progression of metastatic colorectal cancer) and one from refractory hemoptysis after isavuconazole was stopped for hepatotoxicity. In this small heterogeneous cohort, isavuconazole appeared well tolerated and was a feasible alternative to voriconazole when prolonged adjunctive therapy was required alongside bronchoscopic or medical management of pulmonary aspergilloma and CCPA. Larger comparative studies are needed to define its place in multimodal protocols.
Pulmonary histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, can present as solitary pulmonary nodules with granulomatous inflammation that radiologically and metabolically mimic malignant lesions, posing a significant diagnostic challenge in patients with a history of lung cancer. We report a case of a 69-year-old asymptomatic male with a prior left upper lobe adenocarcinoma resected in 2019, who presented with a new growing, hypermetabolic nodule in the left lower lobe during routine oncologic surveillance in December 2025. Sequential computed tomography (CT) demonstrated interval growth, and positron emission tomography (PET-CT) revealed intense fluorodeoxyglucose (FDG) uptake (SUVmax 7.2), strongly suggesting recurrence. Video-assisted thoracoscopic segmentectomy was performed; histopathological examination revealed chronic necrotizing granulomatous inflammation, with Grocott methenamine silver staining confirming small yeast forms consistent with Histoplasma spp. No malignancy was identified. This case underscores the diagnostic pitfall of fungal infections mimicking cancer recurrence in endemic regions and the indispensable role of histopathological confirmation prior to initiating systemic oncologic therapy.
Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disorder characterized by accumulation of lipoproteinaceous surfactant material within alveoli, leading to impaired gas exchange. While autoimmune PAP, mediated by granulocyte/macrophage colony-stimulating factor (GM-CSF) autoantibodies, represents the most common form, emerging environmental exposures have been implicated as potential triggers. Electronic cigarettes (e-cigarette) use, or vaping, has recently been reported in a limited number of cases as a possible contributing factor in the development of PAP.We report a case of PAP in a young woman with a history of chronic vaping exposure, whose diagnostic evaluation confirmed the presence of circulating GM-CSF autoantibodies, supporting an autoimmune process linking the association between vaping and PAP.
We describe the case of a 68-year-old woman who presented with intermittent haemoptysis and a significant family history of lung cancer. A non-contrast CT thorax was unremarkable aside from minor right lower lobe scarring. Flexible bronchoscopy demonstrated a pulsatile endobronchial lesion within the posterior basal segment of the right lower lobe bronchus. Given its pulsatile appearance, biopsy was deferred because of concern for an underlying vascular lesion. Bronchoalveolar lavage was negative for malignancy and infection. Subsequent rigid bronchoscopy confirmed the lesion, with no evidence of mucosal disruption or active bleeding.CT pulmonary angiography, performed only after the bronchoscopic findings, demonstrated a focal pulmonary arterial vascular anomaly. A vascular loop arising from a segmental right lower lobe pulmonary artery corresponded to the bronchoscopic abnormality. There was no evidence of aneurysm, arteriovenous malformation, or pulmonary embolism. In view of the reassuring imaging findings and the patient’s clinical stability, a conservative management approach was adopted. She remained symptom-free at six-month follow-up.This case highlights the importance of recognising potential vascular lesions during bronchoscopy to avoid catastrophic iatrogenic bleeding. Visible pulsatility should prompt immediate avoidance of biopsy and further evaluation with contrast-enhanced vascular imaging and endobronchial ultrasound.
Diffuse pulmonary meningotheliomatosis (DPM) is an ultrarare diffuse parenchymal lung disease in which pulmonary meningothelial-like nodules produce a miliary radiographic pattern. Most reported cases are asymptomatic and incidentally detected, and longitudinal physiologic data in symptomatic patients remain scarce. A 52-year-old postmenopausal never-smoker presented with three months of progressive exertional dyspnea. High-resolution computed tomography showed innumerable small bilateral nodules in a diffuse, random miliary distribution. A non-dedicated chest CT obtained approximately three months earlier had not described nodules. Serologic and microbiologic workup was unrevealing, and bronchoscopy was nondiagnostic. Video-assisted thoracoscopic wedge resection showed bland spindle-cell nests, and immunohistochemistry established DPM. Serial pulmonary function testing showed moderate restriction with reduced diffusing capacity and alveolar volume. During follow-up, forced vital capacity and six-minute walk distance improved, while static volumes and the diffusing-capacity deficit persisted. Severe obesity likely contributed to the restrictive defect. At reduced alveolar volume, the transfer coefficient (KCO) remained lower than expected for pure extrapulmonary restriction, raising the possibility of an intrinsic pulmonary component. However, obesity, possible pulmonary vascular disease, and other factors precluded attribution of these abnormalities to DPM alone. Management was conservative, without corticosteroids, and the disease burden remained radiographically stable. Symptomatic DPM may show functional improvement despite persistent restriction and impaired diffusing capacity. DPM should be considered among the causes of diffuse miliary opacities when imaging and serologic evaluation are nondiagnostic.
Background:Primary mediastinal Ewing sarcoma is an exceptionally rare and aggressive malignancy that may rapidly lead to life-threatening compression of mediastinal structures. Management is particularly challenging when critical airway obstruction is present. Case presentation:A 38-year-old woman presented with progressive dyspnea and cough. Chest imaging revealed a large right paratracheal mediastinal mass causing severe extrinsic tracheal compression with near-complete airway narrowing. Diagnosis was established by EBUS-TBNA, and histopathological and immunohistochemical findings were consistent with Ewing sarcoma. Given the imminent risk of respiratory failure, diagnostic EBUS-TBNA and airway stenting were performed during the same procedural session under general anesthesia. A fully covered self-expanding metallic stent was placed to secure the airway and enable safe initiation of systemic chemotherapy. The patient subsequently received VAC/IE chemotherapy. Follow-up imaging demonstrated marked tumor regression, and the stent was successfully removed after three months. At 6-month follow-up, the patient remained asymptomatic without clinical or radiological evidence of recurrence. Conclusion:Temporary tracheal stenting may serve as an effective bridge to definitive therapy in selected patients with mediastinal Ewing's sarcoma and critical airway obstruction. Multidisciplinary management is essential in such high-risk cases.
Purpose:To explore the feasibility and preliminary behavior of the Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) tool in detecting radiologic differences in lung parenchyma of lung transplant recipients undergoing extracorporeal photopheresis (ECP) for chronic lung allograft dysfunction (CLAD). Methods:We performed a retrospective case review on a series of adult lung transplant recipients at Mayo Clinic who had a baseline CT following transplant, underwent ECP for CLAD, and had follow-up CT imaging. Our primary outcome was temporal change in lung parenchymal morphology exemplars assessed by CALIPER. Secondary outcomes included changes in distribution of vascular-related structures, calculated lung volumes, and spirometric indices. Data was analyzed using a linear mixed effects model. Findings:Of 91 eligible recipients with CLAD, 15 were treated with ECP. Following ECP we observed an increase in normal lung tissue (p = 0.038) and a decrease in interstitial lung abnormalities (p = 0.003). There was no significant difference in hyperlucent areas, distribution of pulmonary vascular-related structures, or calculated lung volumes. There was a slight increase in FVC (p < 0.001) after initiation of ECP, but no significant change in FEV1. Conclusions:Initiation of ECP was associated with favorable parenchymal changes as calculated by CALIPER in this sample of patients.
Bronchial papillomas have a median diameter of 15 mm at diagnosis and are classified as benign tumors; however, they may occasionally demonstrate increased fluorodeoxyglucose (FDG) uptake, requiring differentiation from malignant tumors. A 64-year-old man was referred to our hospital after chest computed tomography (CT) performed to evaluate a cough during a routine workplace health checkup revealed a 60-mm mass in segment 6 (S6) of the right lower lobe. The serum levels of carcinoembryonic antigen, cytokeratin 19 fragment, and squamous cell carcinoma antigen were elevated. FDG positron emission tomography/CT demonstrated intense FDG uptake in the right S6 mass, with a maximum standardized uptake value of 23.21. Bronchoscopy revealed a tumor protruding into the right B6 bronchus. Direct biopsy of the endobronchial lesion revealed a papilloma-like lesion composed of stratified mature squamous epithelium. Although no definite malignant features were identified, the possibility of secondary hyperplastic/dysplastic changes associated with neighboring malignancies, such as squamous cell carcinoma, could not be completely excluded. To evaluate the lesion, a CT-guided percutaneous lung biopsy was performed, which revealed similar histological findings without evidence of malignancy. As malignancy could not be definitively excluded, diagnostic and therapeutic surgery, consisting of uniportal video-assisted thoracoscopic right lower lobectomy with bronchoplasty and ND2a-1 lymph node dissection, was performed. Histopathological examination revealed a squamous cell papilloma measuring approximately 46 mm in diameter, with no evidence of malignancy. This squamous cell papilloma was larger and demonstrated higher FDG uptake, compared with previous cases.
Chronic kidney disease predisposes patients to the development of pulmonary hypertension (PH) via multiple potential mechanisms. AV fistulas have been found to be superior to AV grafts in terms of maintaining patency, however unlike grafts fistulas can expand significantly over time which predisposes patients to high output heart failure and subsequent PH. This report demonstrates a case of newly diagnosed pre-capillary PH in a young patient presenting with dyspnea. The patient had an AV fistula placed 18 years prior to presentation for CKD and ultimately underwent transplantation. Pulmonary angiography was negative for PE and echocardiography demonstrated an elevated RVSP of 67 mmHg that was confirmed via right heart catheterization. This case was unique in that the patient's pre-capillary PH was reversed after AV fistula ligation and the patient also experienced improvement in renal graft function (Cr 1.43 to 1.2 mg/dL). AV fistulas can have a significant effect on cardiac function and clinicians should survey patients with AV fistulas for PH via screening echocardiography. Fistulas with outputs greater than 1.5-2 L/min should be considered for revision or ligation to decrease the risk of development of PH.
Background:High-dose trimethoprim-sulfamethoxazole (TMP-SMX) combined with corticosteroids is the first-line treatment for severe Pneumocystis jirovecii pneumonia (PJP) in HIV patients but carries a risk of severe hyperkalemia and muscle weakness. Case presentation:We report a 56-year-old male with advanced HIV (CD4: 14 cells/μL) and type 2 diabetes mellitus, treated for PJP with TMP-SMX 20 mg/kg/day and methylprednisolone 80 mg/day. On day 10 of treatment, the patient developed severe muscle weakness and life-threatening hyperkalemia (8.2 mmol/L) unresponsive to medical management, requiring emergency intermittent hemodialysis (IHD). After one hemodialysis session and switching to clindamycin-primaquine, potassium levels normalized within 2 days, and muscle weakness gradually improved and resolved after 4 days. The patient was discharged in a stable condition after 21 days of treatment. Conclusion:This case represents a rare clinical complication with extremely severe hyperkalemia (8.2 mmol/L) accompanied by muscle weakness, likely due to the synergistic effect of hyperkalemia and steroid myopathy. Hemodialysis is an effective and safe intervention for hyperkalemia unresponsive to medical management. Close monitoring of electrolytes and muscle function is crucial in patients receiving high-dose TMP-SMX in combination with corticosteroids, particularly during the first 10 days of treatment.
Background:Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition characterized by widespread bleeding within the alveoli, often resulting from pulmonary capillaritis, bland pulmonary hemorrhage, or diffuse alveolar damage. It presents with hemoptysis, dyspnea, hypoxemia, and anemia, and can lead to respiratory failure. This case report highlights a rare instance of DAH in a pregnant woman with untreated Graves' disease, emphasizing the importance of considering uncommon etiologies in the absence of typical triggers. Case presentation:A 36-year-old pregnant woman at 37 weeks of gestation presented with hemoptysis and dyspnea. Initial evaluations, including pulmonary CT angiography, ruled out pulmonary embolism but revealed bilateral diffuse alveolar involvement. Bronchoscopy confirmed DAH, with serologic tests indicating hyperthyroidism due to Graves' disease. The patient was treated with pulse methylprednisolone and later methimazole, leading to symptom resolution. She delivered a healthy baby at 40 weeks via uncomplicated vaginal delivery. Discussion:DAH during pregnancy is rare, and its association with untreated Graves' disease is exceptionally uncommon. In this case, untreated Graves' disease may have contributed to left ventricular diastolic dysfunction, exerting shear stress on pulmonary vasculature and potentially resulting in DAH. The absence of coagulopathy, environmental exposures, or autoantibodies supported this conclusion. This case underscores the need to consider thyroid disorders in the differential diagnosis of bland pulmonary hemorrhage, particularly when other causes are excluded. Early identification and management of underlying causes can significantly improve maternal and fetal outcomes. This report highlights the importance of exploring rare etiologies in cases of DAH, especially in pregnant patients, to ensure timely and effective intervention.
