An Interesting Autopsy case Report of Acute Respiratory Failure | Original Article

ABSTRACT:

Introduction Acute respiratory distress comes with a lot of etiological factors. The least common among it is, diffuse alveolar hemorrhage which constitutes more than 50 of the mortality rate. One of the least common cause of diffuse alveolar hemorrhage is Small vessel vasculitis. Vasculitis is a group of rare but potentially serious disorders characterized by inflammation of blood vessels. Clinical profile Vasculitis presents with multiple etiological factors, but it is believed to involve an abnormal immune response. The immune system mistakenly attacks healthy blood vessels, leading to inflammation. Some cases of vasculitis are linked to autoimmune disorders, where the body's immune system attacks its tissues. Other possible triggers include infections, certain medications, and exposure to toxins.The affected individual presents with fatigue, muscle pain, fever, cough, hemoptysis , abdominal pain, blood in urine or weakness and numbness in hands or feet. In severe cases there is presence of blood and protein in urine , making it appear brownish and foamy , high blood pressure and respiratory problem Results Diagnosing vasculitis can be complex, as its symptoms often overlap with other medical conditions. The prognosis is extremely poor if not diagnosed in time. Hence better clinical history and adequate tests like test for ANCA antibodies, LFT and KFT is extremely important. Treatment for vasculitis aims to control inflammation, alleviate symptoms, and prevent further damage to organs. The approach often involves administration of corticosteroids, immunosuppressants, biological therapies, plasmapheresis and supportive care Discussion A 29 year old serving soldier was admitted with complains of fever, pain abdomen, hemoptysis, bodyache and dark coloured urine since 03 days. On admission patient was tachypneic and hypotensive. Blood investigations revealed decrease hemoglobin and platelet count. pANCA came out to be positive. Despite management with oxygenation, iv fluids and iv antibiotics, there was no improvement in his symptoms and his condition further deteriorated. Bronchoscopy revealed diffuse bronchoalveolar hemorrhage. Biochemical evaluation revealed deranged kidney and liver function test. Patient on ventilation developed bradycardia, hypotension and desaturation. On examination blood pressure was not recordable, carotid pulse was not recordable, CPR was started and patient was declared dead at 1215hrs on 30 Oct 2020. Conclusion Vasculitis is a rare autoimmune disorder and hence its diagnosis is extremely challenging. There is no god standard or clinical criteria to diagnose a case of vasculitis. Hence early diagnosis and medical intervention is extremely important to improve long term survival.