When extubation turns fatal: Delayed hemoptysis from negative pressure pulmonary hemorrhage

Negative pressure pulmonary hemorrhage (NPPH) is a rare but serious complication following upper airway obstruction, often due to forceful inspiratory efforts. We report a case of a 25-year-old diabetic male who developed sudden hemoptysis and dyspnea after routine varicocelectomy. The patient had likely bitten the endotracheal tube during extubation, causing transient airway obstruction. Imaging showed bilateral pulmonary infiltrates consistent with alveolar hemorrhage. Other causes were excluded, and supportive treatment led to full recovery. This case underscores the importance of recognizing NPPH early in the postoperative period to prevent misdiagnosis and ensure prompt, effective management.