Life-threatening diffuse alveolar hemorrhage associated with Rhinovirus infection and the potential role of corticosteroids in immunocompetent patients: Case reports.
Chang-Seok Yoon, Joon-Young Yoon, Bo-Gun Kho et al.
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Case in brief
Two immunocompetent women, aged 85 and 70, presented with severe hypoxemia and hemoptysis or worsening dyspnea. Chest CT showed diffuse or bilateral ground-glass opacities and consolidations. In both, bronchoalveolar lavage became progressively bloodier, supporting diffuse alveolar hemorrhage; multiplex PCR detected rhinovirus as the sole pathogen, and autoimmune serologies were negative. Both received high-flow oxygen, empirical antibiotics, and systemic corticosteroids. Their hypoxemia and imaging findings improved rapidly, and both were discharged within 10 days.
What made this case unusual
Life-threatening diffuse alveolar hemorrhage occurred in two immunocompetent patients with rhinovirus identified as the sole pathogen, an uncommon association for a virus usually linked to upper respiratory infection.
Diagnostic / clinical pearl
In severe alveolar hemorrhage with negative autoimmune testing, rhinovirus may be an infectious trigger; progressively hemorrhagic bronchoalveolar lavage aliquots supported the diagnosis in these cases.
Why it matters
Both patients improved after systemic corticosteroids, raising a potential therapeutic role in selected severe cases, although these case reports cannot establish treatment efficacy.