Diffuse Alveolar Hemorrhage Following Trauma: A Diagnostic Dilemma With Rapid Steroid Response

Diffuse alveolar hemorrhage (DAH) is a rare but potentially life-threatening pulmonary condition that, while classically linked to autoimmune disorders, can occur in the setting of trauma. We report the case of a 20-year-old male who sustained polytrauma following a road traffic accident and initially had a normal chest radiograph. On the fourth day of hospitalization, he developed acute hypoxemia with new bilateral alveolar infiltrates; high-resolution computed tomography revealed diffuse ground-glass opacities with septal thickening. Bronchoalveolar lavage demonstrated progressively hemorrhagic return across aliquots, confirming DAH. Autoimmune markers were largely negative, and in the absence of systemic features, a multifactorial etiology involving trauma-related injury and anticoagulant use was considered. High-dose intravenous corticosteroids produced rapid clinical and radiological recovery. This case underscores the importance of considering DAH in trauma patients presenting with unexplained hypoxemia and bilateral infiltrates, even without hemoptysis, where early bronchoscopy and prompt treatment can be lifesaving.