Diffuse alveolar haemorrhage in granulomatosis with polyangitis (Wegener's) with coexistent rheumatoid arthritis

Diffuse alveolar haemorrhage is a serious manifestation of granulomatosis with polyangitis (Wegener's) with high morbidity and mortality. It is defined by the clinical triad of haemoptysis, anaemia and progressive hypoxaemia. The diagnosis of granulomatosis with polyangitis is confirmed in an appropriate clinical setting by bronchoalveolar lavage, lung biopsy or detection of C-antineutrophil cytoplasmic antibodies. In this report, the patient was a known case of rheumatoid arthritis and presented with diffuse alveolar haemorrhage on CT scan; the underlying cause was found to be granulomatosis with polyangitis (Wegener's) with positive C-antineutrophil cytoplasmic antibodies. Despite aggressive treatment with immunosuppressants and steroids the patient died within a few days.