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Case Report
Diffuse alveolar hemorrhage secondary to antiphospholipid syndrome presenting as recurrent multifocal pneumonia
1 Baylor Scott and White Medical Center, Round Rock, TX, USA
2 Texas A&M Naresh K. Vashisht College of Medicine, Bryan, TX, USA
Address correspondence to:
Srujan Kancharla
MD, MEng, Baylor Scott and White Medical Center, Round Rock, TX,
USA
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Article ID: 100032Z14SK2026
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Kancharla S, Maza CH, Goraya JS. Diffuse alveolar hemorrhage secondary to antiphospholipid syndrome presenting as recurrent multifocal pneumonia. J Case Rep Images Orthop Rheum 2026;9(1):1–5.ABSTRACT
Introduction: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening pulmonary manifestation of antiphospholipid syndrome (APS) that may present with nonspecific symptoms and radiographic findings mimicking infection, leading to delayed diagnosis. Early recognition is critical given its high relapse rates and associated morbidity despite immunosuppressive therapy.
Case Report: A 31-year-old woman with APS and chronic pulmonary embolism presented with progressive hypoxemia and recurrent multifocal pulmonary infiltrates, initially treated as pneumonia despite repeatedly negative infectious evaluations. Surgical lung biopsy demonstrated pulmonary capillaritis with hemosiderin-laden macrophages consistent with DAH due to APS, an immune-mediated injury to pulmonary vasculature. The patient initially improved with corticosteroid therapy but experienced relapses during steroid tapering and failed Rituximab despite appropriate CD20 depletion. She subsequently required escalation to cyclophosphamide and adjunctive plasma exchange with clinical stabilization.
Conclusion: Antiphospholipid syndrome-associated DAH should be considered in patients with persistent pulmonary infiltrates and unexplained hypoxemic respiratory failure despite antimicrobial therapy. Early diagnosis is essential, as treatment-refractory disease may require escalation beyond corticosteroids to additional immunosuppressive therapies.
Keywords: Antiphospholipid syndrome, Cyclophosphamide, Diffuse alveolar hemorrhage, Hypoxemic respiratory failure
SUPPORTING INFORMATION
Author Contributions
Srujan Kancharla - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Claire Heigl Maza - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jadvinder Singh Goraya - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Srujan Kancharla et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
