A case report of pregnancy complicated by diffuse alveolar hemorrhage: An unexpected link to untreated Graves' disease.

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.