Skip to main content

Advertisement

SpringerLink
Log in

Differentiation of idiopathic pulmonary hemosiderosis from rheumatologic and autoimmune diseases causing diffuse alveolar hemorrhage: establishing a diagnostic approach

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This narrative review provides an overview of diffuse alveolar hemorrhage (DAH) associated with rheumatologic and autoimmune diseases and their differentiation from idiopathic pulmonary hemosiderosis (IPH). Relevant immunologic diseases associated with DAH are discussed, and a diagnostic flowchart is proposed to establish a “definitive” diagnosis of IPH within the spectrum of DAH. IPH is a rare cause of recurrent DAH both in children and adults. In adults, a definitive diagnosis of IPH requires a lung biopsy and histopathologic examination demonstrating intraalveolar hemorrhage, hemosiderin-laden macrophages, and a variable degree of fibrosis in the absence of both capillaritis and cellular inflammation. The presence of small vessel vasculitis points towards immunologic, well-differentiated, or sometimes undifferentiated rheumatologic diseases. However, it is essential to recognize that many rheumatologic diseases may in the initial phase present with DAH without any evidence of capillaritis, thus mimicking IPH. Although not definitely established, it is likely that immunologic processes are involved in IPH, and we, therefore, suggest the consideration of a more suitable term for the disease, e.g., “Immune-mediated Pulmonary Hemosiderosis” to acknowledge the aberrancy in the immune parameters and a positive response to immunosuppressive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AAV :

ANCA-associated vasculitis

ANA:

Antinuclear antibody

ANCA:

Anti-neutrophil cytoplasmic antibody

BAL:

Bronchoalveolar lavage

BH:

Bland pulmonary hemorrhage

c-ANCA:

Cytoplasmic anti-neutrophil cytoplasmic antibody

CPK:

Creatine phosphokinase

CTD:

Connective tissue disease

DAD:

Diffuse alveolar damage

DAH:

Diffuse alveolar hemorrhage

DM:

Dermatomyositis

GCA:

Giant cell arteritis

IPH:

Idiopathic pulmonary hemosiderosis

LVV:

Large vessel vasculitis

MVV:

Medium vessel vasculitis

PAN:

Polyarteritis nodosa

p-ANCA:

Perinuclear anti-neutrophil cytoplasmic antibody

PM:

Polymyositis

RD:

Rheumatologic disease

SLE:

Systemic lupus erythematosus

TAK:

Takayasu arteritis

VATS:

Video-assisted thoracoscopic surgery

VVV:

Variable vessel vasculitis

References

  1. Chen X-Y, Sun J-M, Huang X-J (2017) Idiopathic pulmonary hemosiderosis in adults: review of cases reported in the latest 15 years. Clin Respir J 11:677–681

    PubMed  Google Scholar 

  2. Kjellman B, Elinder G, Garwicz S, Svan H (1984) Idiopathic pulmonary haemosiderosis in Swedish children. Acta Paediatr 73:584–588

    CAS  Google Scholar 

  3. Ohga S, Takahashi K, Miyazaki S et al (1995) Idiopathic pulmonary haemosiderosis in Japan: 39 possible cases from a survey questionnaire. Eur J Pediatr 154:994–995

    CAS  PubMed  Google Scholar 

  4. Milman N, Pedersen FM (1998) Idiopathic pulmonary haemosiderosis. Epidemiology, pathogenic aspects and diagnosis. Respir Med 92:902–907

    CAS  PubMed  Google Scholar 

  5. Milman N Idiopathic pulmonary hemosiderosis. In: Post TW (ed) UpToDate. UpToDate Inc., Waltham. http://www.uptodate.com. Accessed March 21, 2021

  6. Saha BK, Milman NT (2021) Idiopathic pulmonary hemosiderosis: a review of the treatments used during the past 30 years and future directions. Clin Rheumatol 40:2547–2557

    PubMed  Google Scholar 

  7. Saha BK (2020) Idiopathic pulmonary hemosiderosis: a state of the art review. Respir Med 176:106234

    PubMed  Google Scholar 

  8. Green RJ, Ruoss SJ, Kraft SA et al (1996) Pulmonary capillaritis and alveolar hemorrhage. Update on diagnosis and management. Chest 110:1305–1316

    CAS  PubMed  Google Scholar 

  9. Lara AR, Schwarz MI (2010) Diffuse alveolar hemorrhage. Chest 137:1164–1171

    PubMed  Google Scholar 

  10. The diffuse alveolar hemorrhage syndromes - UpToDate. https://www.uptodate.com/contents/the-diffuse-alveolar-hemorrhage-syndromes?search=DAH%20syndromes&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed 19 Nov 2020

  11. Lichtenberger JP, Digumarthy SR, Abbott GF et al (2014) Diffuse pulmonary hemorrhage: clues to the diagnosis. Curr Probl Diagn Radiol 43:128–139

    PubMed  Google Scholar 

  12. Castañer E, Alguersuari A, Gallardo X et al (2010) When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics 30:33–53

    PubMed  Google Scholar 

  13. Ali AM, Milman N, Clausen PP, Reinert P, Pedersen FM, Jacobsen GK (1999) Idiopathic pulmonary haemosiderosis. Favourable effect of oral corticosteroids in two females aged 16 and 55 yrs. Eur Respir Top 4:53–57

  14. Allue X, Wise MB, Beaudry PH (1973) Pulmonary function studies in idiopathic pulmonary hemosiderosis in children. Am Rev Respir Dis 107(3):410–415

  15. Ewan PW, Jones HA, Rhodes CG, Hughes JM (1976) Detection of intrapulmonary hemorrhage with carbon monoxide uptake. Application in Goodpasture’s syndrome. N Engl J Med 295:1391–1396

    CAS  PubMed  Google Scholar 

  16. Custer G, Balcerzak S, Rinehart J (1982) Human macrophage hemoglobin-iron metabolism in vitro. Am J Hematol 13:23–36

    CAS  PubMed  Google Scholar 

  17. de Prost N, Parrot A, Picard C et al (2010) Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality. Eur Respir J 35:1303–1311

    PubMed  Google Scholar 

  18. Chin CIC, Kohn SL, Keens TG et al (2015) A physician survey reveals differences in management of idiopathic pulmonary hemosiderosis. Orphanet J Rare Dis 10:98. https://doi.org/10.1186/s13023-015-0319-5

    Article  PubMed  PubMed Central  Google Scholar 

  19. Taytard J, Nathan N, de Blic J et al (2013) New insights into pediatric idiopathic pulmonary hemosiderosis: the French RespiRare(®) cohort. Orphanet J Rare Dis 8:161. https://doi.org/10.1186/1750-1172-8-161

    Article  PubMed  PubMed Central  Google Scholar 

  20. Freitas A, Senra V, Marinho A, Guedes M (2015) Chronic alveolar haemorrhage in a paediatric patient: a diagnostic and treatment challenge. BMJ Case Rep 2015:bcr2014206856. https://doi.org/10.1136/bcr-2014-206856

  21. Yanagihara T, Yamamoto Y, Hamada N et al (2018) Recurrent idiopathic pulmonary hemosiderosis after long-term remission presented with Sjogren’s syndrome: idiopathic no more? Respir Med Case Rep 25:68–72

    PubMed  PubMed Central  Google Scholar 

  22. Khemiri M, Ouederni M, Khaldi F, Barsaoui S (2008) Screening for celiac disease in idiopathic pulmonary hemosiderosis. Gastroenterol Clin Biol 32:745–748

    CAS  PubMed  Google Scholar 

  23. Sethi GR, Singhal KK, Puri AS, Mantan M (2011) Benefit of gluten-free diet in idiopathic pulmonary hemosiderosis in association with celiac disease. Pediatr Pulmonol 46:302–305

    PubMed  Google Scholar 

  24. Le Clainche L, Le Bourgeois M, Fauroux B et al (2000) Long-term outcome of idiopathic pulmonary hemosiderosis in children. Medicine (Baltimore) 79:318–326

    Google Scholar 

  25. Saha BK (2021) Is it time to call idiopathic pulmonary hemosiderosis by the correct name: immune-mediated pulmonary hemosiderosis? Am J Med Sci 361:809–811

    PubMed  Google Scholar 

  26. Ioachimescu OC, Sieber S, Kotch A (2004) Idiopathic pulmonary haemosiderosis revisited. Eur Respir J 24:162–169

    CAS  PubMed  Google Scholar 

  27. Donald KJ, Edwards RL, McEvoy JD (1975) Alveolar capillary basement membrane lesions in Goodpasture’s syndrome and idiopathic pulmonary hemosiderosis. Am J Med 59:642–649

    CAS  PubMed  Google Scholar 

  28. Stainer A, Rice A, Devaraj A et al (2019) Diffuse alveolar haemorrhage associated with subsequent development of ANCA positivity and emphysema in three young adults. BMC Pulm Med 19:185

    PubMed  PubMed Central  Google Scholar 

  29. Buckley M, Van Mater H (2020) Idiopathic pulmonary hemosiderosis as a mimic of pulmonary vasculitis: a case report and review of the literature. Curr Allergy Asthma Rep 20:13

    PubMed  Google Scholar 

  30. Saha BK, Chong WH (2021) Lung transplant to manage end-stage lung disease due to idiopathic pulmonary hemosiderosis: a review of the literature. Respir Investig. https://doi.org/10.1016/j.resinv.2021.06.009

    Article  PubMed  PubMed Central  Google Scholar 

  31. Merkel PA, Polisson RP, Chang Y et al (1997) Prevalence of antineutrophil cytoplasmic antibodies in a large inception cohort of patients with connective tissue disease. Ann Intern Med 126:866–873

    CAS  PubMed  Google Scholar 

  32. Jennette JC (2013) Overview of the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Clin Exp Nephrol 17:603–606

    PubMed  PubMed Central  Google Scholar 

  33. Jennette JC, Falk RJ, Bacon PA et al (2013) 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11

    CAS  PubMed  Google Scholar 

  34. Pepmueller PH (2016) Undifferentiated connective tissue disease, mixed connective tissue disease, and overlap syndromes in rheumatology. Mo Med 113:136–140

    PubMed  PubMed Central  Google Scholar 

  35. Zamora MR, Warner ML, Tuder R, Schwarz MI (1997) Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome. Medicine (Baltimore) 76:192–202

    CAS  Google Scholar 

  36. Collard HR, Schwarz MI (2004) Diffuse alveolar hemorrhage. Clin Chest Med 25:583–592 (vii)

    PubMed  Google Scholar 

  37. Samuel S, Brown B, Mason N, Abdo T (2020) Diffuse alveolar hemorrhage, a rare presentation of polymyositis. Respir Med Case Rep 31:101261. https://doi.org/10.1016/j.rmcr.2020.101261

  38. Falk RJ, Jennette JC (2010) ANCA disease: where is this field heading? J Am Soc Nephrol 21:745–752

    CAS  PubMed  Google Scholar 

  39. Fishbein GA, Fishbein MC (2011) Lung vasculitis and alveolar hemorrhage: pathology. Semin Respir Crit Care Med 32:254–263

    PubMed  Google Scholar 

  40. Frankel SK, Schwarz MI (2012) The pulmonary vasculitides. Am J Respir Crit Care Med 186:216–224

    CAS  PubMed  Google Scholar 

  41. Tamai K, Tomii K, Nakagawa A et al (2015) Diffuse alveolar hemorrhage with predominantly right-sided infiltration resulting from cardiac comorbidities. Intern Med Tokyo Jpn 54:319–324

    Google Scholar 

  42. Saha S, Chong WH, Saha BK (2021) Unilateral diffuse alveolar hemorrhage due to selective directionality of mitral regurgitant jet in a patient with severe aortic stenosis. Cureus 13:e14714

    PubMed  PubMed Central  Google Scholar 

  43. Andrade C, Mendonça T, Farinha F et al (2016) Alveolar hemorrhage in systemic lupus erythematosus: a cohort review. Lupus 25:75–80

    CAS  PubMed  Google Scholar 

  44. Byrd RB, Trunk G (1973) Systemic lupus erythematosus presenting as pulmonary hemosiderosis. Chest 64:128–129

    CAS  PubMed  Google Scholar 

  45. Hotchi M (1992) Pathological studies on Takayasu arteritis. Heart Vessels 7:11–17

    CAS  Google Scholar 

  46. Takayasu’s arteritis presenting with bilateral parenchymal consolidations and severe respiratory failure - ProQuest. https://www-proquest-com.arktos.nyit.edu/docview/228296747?accountid=12917. Accessed 16 Nov 2020

  47. Guggenberger KV, Bley TA (2020) Imaging in vasculitis. Curr Rheumatol Rep 22:34

    PubMed  PubMed Central  Google Scholar 

  48. Nasu T (1982) Takayasu’s truncoarteritis Pulseless disease or aortitis syndrome. Acta Pathol Jpn 32 Suppl 1:117–131

    CAS  PubMed  Google Scholar 

  49. Koyabu S, Isaka N, Yada T et al (1993) Severe respiratory failure caused by recurrent pulmonary hemorrhage in Takayasu’s arteritis. Chest 104:1905–1906

    CAS  PubMed  Google Scholar 

  50. Huong DLT, Andreu MR, Duhaut P et al (2003) Intra-alveolar haemorrhage in temporal arteritis. Ann Rheum Dis 62:189–190

    Google Scholar 

  51. Grayson PC, Alehashemi S, Bagheri AA et al (2018) 18 F-fluorodeoxyglucose-positron emission tomography as an imaging biomarker in a prospective, longitudinal cohort of patients with large vessel vasculitis. Arthritis Rheumatol 70:439–449

    PubMed  PubMed Central  Google Scholar 

  52. Ozen S (2017) The changing face of polyarteritis nodosa and necrotizing vasculitis. Nat Rev Rheumatol 13:381–386

    PubMed  Google Scholar 

  53. Guo X, Gopalan R, Ugbarugba S et al (2001) Hepatitis B-related polyarteritis nodosa complicated by pulmonary hemorrhage. Chest 119:1608–1610

    CAS  PubMed  Google Scholar 

  54. Taj A, Kanjwal S, Assaly RA, Hammersley JR (2008) Pulmonary capillaritis in a classical polyarteritis nodosa. Internet J Pulm Med 11(2)

  55. Yazici H, Seyahi E, Hatemi G, Yazici Y (2018) Behçet syndrome: a contemporary view. Nat Rev Rheumatol 14:107–119

    CAS  PubMed  Google Scholar 

  56. Yurdakul S, Hamuryudan V, Yazici H (2004) Behçet syndrome. Curr Opin Rheumatol 16:38–42

    PubMed  Google Scholar 

  57. Seyahi E, Melikoglu M, Akman C et al (2012) Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine (Baltimore) 91:35–48

    Google Scholar 

  58. Esatoglu SN, Seyahi E, Ugurlu S et al (2016) Bronchial artery enlargement may be the cause of recurrent haemoptysis in Behçet’s syndrome patients with pulmonary artery involvement during follow-up. Clin Exp Rheumatol 34:92–96

    PubMed  Google Scholar 

  59. Chae EJ, Do K-H, Seo JB et al (2008) Radiologic and clinical findings of behçet disease: comprehensive review of multisystemic involvement. Radiographics 28:e31

    PubMed  Google Scholar 

  60. Falk RJ, Jennette JC (1997) ANCA small-vessel vasculitis. J Am Soc Nephrol 8:314–322

    CAS  PubMed  Google Scholar 

  61. de Prost N, Parrot A, Cuquemelle E et al (2012) Diffuse alveolar hemorrhage in immunocompetent patients: etiologies and prognosis revisited. Respir Med 106:1021–1032

    PubMed  Google Scholar 

  62. West S, Arulkumaran N, Ind PW, Pusey CD (2013) Diffuse alveolar haemorrhage in ANCA-associated vasculitis. Intern Med Tokyo Jpn 52:5–13

    Google Scholar 

  63. Finkielman JD, Lee AS, Hummel AM et al (2007) ANCA are detectable in nearly all patients with active severe Wegener’s granulomatosis. Am J Med 120:643.e9–14

    Google Scholar 

  64. Guillevin L, Durand-Gasselin B, Cevallos R et al (1999) Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 42:421–430

    CAS  PubMed  Google Scholar 

  65. Radice A, Bianchi L, Sinico RA (2013) Anti-neutrophil cytoplasmic autoantibodies: methodological aspects and clinical significance in systemic vasculitis. Autoimmun Rev 12:487–495

    CAS  PubMed  Google Scholar 

  66. Mollaeian A, Chan N, Aloor R et al (2021) ANCA-negative microscopic polyangiitis with diffuse alveolar hemorrhage masquerading as congestive heart failure. Autoimmun Highlights 12:1

    CAS  Google Scholar 

  67. Fauci AS, Haynes BF, Katz P, Wolff SM (1983) Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 98:76–85

    CAS  PubMed  Google Scholar 

  68. Hoffman GS, Kerr GS, Leavitt RY et al (1992) Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 116:488–498

    CAS  PubMed  Google Scholar 

  69. Bonaci-Nikolic B, Nikolic MM, Andrejevic S et al (2005) Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides. Arthritis Res Ther 7:R1072

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Gao Y, Zhao M-H (2009) Review article: Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Carlton Vic 14:33–41

    CAS  Google Scholar 

  71. McGrath MM, Isakova T, Rennke HG et al (2011) Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease. Clin J Am Soc Nephrol 6:2799–2805

    PubMed  PubMed Central  Google Scholar 

  72. Kalluri R, Wilson CB, Weber M et al (1995) Identification of the alpha 3 chain of type IV collagen as the common autoantigen in antibasement membrane disease and Goodpasture syndrome. J Am Soc Nephrol 6:1178–1185

    CAS  PubMed  Google Scholar 

  73. Sinico RA, Radice A, Corace C et al (2006) Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: a comparison of different assays. Nephrol Dial Transplant 21:397–401

    CAS  PubMed  Google Scholar 

  74. Clavarino G, Gauthier A, Hellmark T et al (2018) Routinely used immunoassays do not detect circulating anti-GBM antibodies against native NC1 hexamer and EA epitope of the α3 chain of type IV collagen. Eur J Immunol 48:1082–1084

    CAS  PubMed  Google Scholar 

  75. Salama AD, Dougan T, Levy JB et al (2002) Goodpasture’s disease in the absence of circulating anti-glomerular basement membrane antibodies as detected by standard techniques. Am J Kidney Dis 39:1162–1167

    PubMed  Google Scholar 

  76. Levy JB, Hammad T, Coulthart A et al (2004) Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int 66:1535–1540

    CAS  PubMed  Google Scholar 

  77. Sun Y, Zhou C, Zhao J et al (2020) Systemic lupus erythematosus-associated diffuse alveolar hemorrhage: a single-center, matched case-control study in China. Lupus 29:795–803

    CAS  PubMed  Google Scholar 

  78. Yachoui R, Sehgal R, Amlani B, Goldberg JW (2015) Antiphospholipid antibodies-associated diffuse alveolar hemorrhage. Semin Arthritis Rheum 44:652–657

    CAS  PubMed  Google Scholar 

  79. Martínez-Martínez MU, Abud-Mendoza C (2011) Predictors of mortality in diffuse alveolar haemorrhage associated with systemic lupus erythematosus. Lupus 20:568–574

    PubMed  Google Scholar 

  80. Deane KD, West SG (2005) Antiphospholipid antibodies as a cause of pulmonary capillaritis and diffuse alveolar hemorrhage: a case series and literature review. Semin Arthritis Rheum 35:154–165

    PubMed  Google Scholar 

  81. Elliott ML, Kuhn C (1970) Idiopathic pulmonary hemosiderosis. Am Rev Respir Dis 102:895–904

    CAS  PubMed  Google Scholar 

  82. Osman A, Galiatsatos P, Bose S, Danoff S (2017) Rheumatoid arthritis causing diffuse alveolar haemorrhage: a novel therapeutic approach. BMJ Case Rep 2017.https://doi.org/10.1136/bcr-2017-220509

  83. Dua R, Rawat J (2014) Diffuse alveolar hemorrhage in a patient of rheumatoid arthritis. Lung India 31:194–195

    PubMed  PubMed Central  Google Scholar 

  84. Henao J, Fernandez R, Arias KT, Chae C (2019) Diffused alveolar hemorrhage in the setting of scleroderma renal crisis. Cureus 11.https://doi.org/10.7759/cureus.4932

  85. Saab H, Bajaj T, Bains K, Garcia-Pacheco R (2019) Recurrent episodes of diffuse alveolar hemorrhage in systemic sclerosis 30 days apart. J Investig Med High Impact Case Rep 7.https://doi.org/10.1177/2324709619846594

  86. Johnston SL, Dudley CRK, Unsworth DJ, Lock RJ (2005) Life-threatening acute pulmonary haemorrhage in primary Sjögren’s syndrome with cryoglobulinaemia. Scand J Rheumatol 34:404–407

    CAS  PubMed  Google Scholar 

  87. Schwarz MI, Zamora MR, Hodges TN et al (1998) Isolated pulmonary capillaritis and diffuse alveolar hemorrhage in rheumatoid arthritis and mixed connective tissue disease. Chest 113:1609–1615

    CAS  PubMed  Google Scholar 

  88. Sanchez-Guerrero J, Cesarman G, Alarcón-Segovia D (1989) Massive pulmonary hemorrhage in mixed connective tissue diseases. J Rheumatol 16:1132–1134

    CAS  PubMed  Google Scholar 

  89. Khaja M, Menon L, Niazi M, Fuentes GD (2012) Diffuse alveolar hemorrhage and acute respiratory distress syndrome during treatment of rheumatoid arthritis with etanercept. J Bronchol Interv Pulmonol 19:228–231

    Google Scholar 

  90. Watanabe T, Takizawa N, Nagasaka T et al (2020) Fatal and extensive multiorgan hemorrhages in antimelanoma differentiation-associated gene 5 antibody-positive dermatomyositis: an autopsy case report. Medicine (Baltimore) 99(3):e18600. https://doi.org/10.1097/MD.0000000000018600

  91. Schwarz MI, Sutarik JM, Nick JA et al (1995) Pulmonary capillaritis and diffuse alveolar hemorrhage. A primary manifestation of polymyositis. Am J Respir Crit Care Med 151:2037–2040

    CAS  PubMed  Google Scholar 

  92. Matsuki Y, Yamashita H, Takahashi Y et al (2012) Diffuse alveolar damage in patients with dermatomyositis: a six-case series. Mod Rheumatol 22:243–248

    PubMed  Google Scholar 

  93. Shoda T, Kotani T, Takeuchi T et al (2009) A fulminant case of systemic sclerosis/dermatomyositis complicating thrombotic microangiopathy and diffuse alveolar hemorrhage. Nihon Kokyuki Gakkai Zasshi 47:227–231

    PubMed  Google Scholar 

  94. Saha BK, Chong WH (2021) Diffuse Alveolar Hemorrhage in Cardiac Diseases. Lung 199:103–112

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA

    Biplab K. Saha

  2. Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA

    Woon H. Chong

  3. Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, 4700, Næstved, Denmark

    Nils T. Milman

Authors
  1. Biplab K. Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Woon H. Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nils T. Milman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were involved in the planning, collection of data and the preparation and finalization of the manuscript.

Corresponding author

Correspondence to Biplab K. Saha.

Ethics declarations

Disclosures

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saha, B.K., Chong, W.H. & Milman, N.T. Differentiation of idiopathic pulmonary hemosiderosis from rheumatologic and autoimmune diseases causing diffuse alveolar hemorrhage: establishing a diagnostic approach. Clin Rheumatol 41, 325–336 (2022). https://doi.org/10.1007/s10067-021-05895-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05895-1

Keywords

Search

Navigation