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Diffuse Lung Disease: Student/Resident Case Report Poster - Diffuse Lung Disease |

Diffuse Alveolar Hemorrhage (DAH) in Hepatitis C Virus (HCV) Associated Cryoglobulinemia After Completion of HCV Therapy

Abhijai Singh, MD; Chandrakanta Chuturvedula, MD; Gurbir GIll, MD; Reshma Abraham, MD; Pieusha Malhotra, MD
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St Vincent Hospital, Shrewsbury, MA


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):530A. doi:10.1016/j.chest.2016.08.544
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SESSION TITLE: Student/Resident Case Report Poster - Diffuse Lung Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: DAH in the setting of cryoglobulinemia after HCV therapy completion is unreported in the absence of glomerular disease.

CASE PRESENTATION: A 62-year-old lady with a past medical history of hypertension, coronary artery disease and hypothyroidism presented with new onset purpuric rash on bilateral lower extremities. . Review of systems was negative except for pruritus around the rash. The patient denied any new medication, sick contacts or tick exposure. On examination the patient was afebrile with normal vitals. Skin revealed palpable purpuric lesions with no significant necrosis. Laboratory workup is summarized in table 1. Skin biopsy came back positive for leukocytoclastic vasculitis. A diagnosis of type 2 mixed cryoglobulinemia (type 2 MC) was established. Patient was started on treatment for hepatitis C with Ledipasvir/Sofosbuvir combination and 12 weeks later patient achieved sustained viral response (SVR). 6 months later, she presented to the emergency department with acute hypoxemic respiratory failure. CT scan identified patch bilateral ground glass opacities. The patient was admitted to the intensive care on Bipap. She underwent an urgent bronchoscopy. Bronchoscopic alveolar lavage was positive for hemosiderin laden alveolar macrophages. A diagnosis of diffuse alveolar hemorrhage (DAH) was established. HCV RNA was documented negative during this admission. Cultures including special stains for pneumocystis were unrevealing. The patient was started on a combination of pulsed methylprednisolone and plasmapheresis and recovered after 5 sessions.

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