Arterial blood gas analysis revealed moderate hypoxemia with a partial pressure of oxygen (P aO2) of 60 mmHg (reference range, 83–108 mmHg) and a partial pressure of carbon dioxide (P aCO2) of 37 mmHg (reference range, 35–45 mmHg) resulting in an elevated alveolar – arterial gradient of 43.5 mmHg (reference estimated age-specific gradient, 17 mmHg). Anti-neutrophil cytoplasmic antibodies (ANCAs) directed against proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA) were negative, as well as antibodies against glomerular basement membrane, antinuclear and antiphospholipid antibodies. Renal function and bilirubin were normal, as were the levels of the liver enzymes. Laboratory analysis showed a normal white blood cell count and C-reactive protein (CRP) and a haemoglobin level of 13.2 g/dL (reference range, 13.2 to 16.8). The lungs were clear on auscultation and the heart rhythm was regular without murmurs.
:max_bytes(150000):strip_icc()/coughing-up-blood-possible-causes-2249394_final_CORRECTED-d935f4f656654c33a3371f83d0c7248c.png "coughing up blood means")
He appeared comfortable, with no signs of respiratory distress. His medication included inhaled formoterol, which he only used as needed, and occasionally ibuprofen.Īt admission the patient’s temperature was 36.2 ☌, blood pressure 163/79 mmHg, heart rate 95 beats per minute and oxygen saturation on pulse oximetry 87% at ambient air. Three weeks before admission he had cleaned a dried-up fishpond. He worked as a librarian and lived with his wife in a rural area. He reported no other relevant medical history. He frequently used nicotine-containing electronic cigarettes (e-cigarettes) and had smoked marijuana occasionally until a few months before admission. The patient was a 30 pack-year current smoker. A recent extensive diagnostic work-up for unintentional weight loss was negative for cancer. He reported no fever, chills, chest pain or worsening dyspnoea. In the spring of 2020, a 58-year-old man with moderate chronic obstructive pulmonary disease (COPD) presented at the emergency department of the referring regional hospital with moderate haemoptysis of acute onset.
#COUGHING UP BLOOD MEANS SERIAL#
This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms.
Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. On the fifth day after admission, he developed massive haemoptysis. Case presentationĪ 58-year-old man presented at the emergency department with acute onset haemoptysis. Fever, cough and fatigue are the most commonly reported clinical symptoms. Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world.
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