case_images: PMC7197000_01
case_images: Posteroanterior chest radiograph showing reticular micronodular opacities bilaterally in the first visit.
case_images: CRIPE2020-5292947.001.jpg
case_images: PMC7197000_01_CRIPE2020-5292947.001.jpg
case_images: fig1
case_images: Chest X-ray indicated bilateral interstitial reticular infiltrates (Figure 1).
case_images: (a) Posteroanterior chest radiography demonstrating bilateral pulmonary infiltrations at three months after first acute alveolar hemorrhage. (b) Axial CT scan of the thorax showing diffuse ground-glass appearance.
case_images: CRIPE2020-5292947.002.jpg
case_images: PMC7197000_01_CRIPE2020-5292947.002.jpg
case_images: fig2
case_images: Three months later, she was again admitted to the hospital for severe anemia with bilateral alveolar infiltrates on chest X-ray (Figure 2(a)). Repeated thoracic CT showed widespread ground-glass appearance throughout both lungs (Figure 2(b)).
case_images: (a) Hemosiderin-laden macrophage within gastric lavage fluid (hematoxylin and eosin stain). (b) Prussian blue stain of gastric lavage fluid.
case_images: CRIPE2020-5292947.003.jpg
case_images: PMC7197000_01_CRIPE2020-5292947.003.jpg
case_images: fig3
case_images: IPH was suspected from clinical manifestation and radiologic findings, and a diagnosis of IPH was confirmed by gastric lavage fluid that demonstrated the presence of hemosiderin-laden macrophages (Figures 3(a) and 3(b)). Intravenous prednisolone (2 mg/kg/day) and blood transfusion were given immediately for acute pulmonary bleeding, and promptly improved clinical symptoms and laboratory data.