title: Severe Alveolar Hemorrhage - What's in it for the Gastroenterologist?
abstract: BACKGROUND
  Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist.
  
  
  METHODS
  We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed.
  
  
  CONCLUSIONS
  Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet.
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Alessandrescu-Rusescu National Institute for Mother and Child Health; Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
authors.forename: Alina
authors.initials: A
authors.lastname: Popp
authors.affiliation: Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania. cjurcut@gmail.com.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Jurcuţ
authors.affiliation: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Daniel Vasile
authors.initials: DV
authors.lastname: Balaban
authors.affiliation: Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Șotcan
authors.affiliation: Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
authors.forename: Kaija
authors.initials: K
authors.lastname: Laurila
authors.affiliation: Carol Davila University of Medicine and Pharmacy; Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Jinga
mesh_terms: D000740:Anemia / Q000209:etiology; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy; D055050:Diet, Gluten-Free; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006469:Hemoptysis / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology*; D006486:Hemosiderosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000098:blood supply*; D012720:Severity of Illness Index; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000097545:Hemosiderosis, Pulmonary
chemical_list: D005938:Glucocorticoids; D011241:Prednisone