Carla Marina Román-Montes, Eduardo Briones-García, Shaul Ariel Navarro-Lara, Marco Antonio Ortiz-Bustamante, Iris Paola García-Herrera, Guillermo Arturo Guaracha-Basañez
Abstract
Diffuse alveolar hemorrhage (DAH) is an uncommon but potentially life-threatening pulmonary complication in patients with rheumatic diseases (RD). Immunosuppression, endothelial injury, and systemic inflammation may increase the risk of pulmonary infections, further complicating clinical management and worsening outcomes.
Introduction
Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening complication of rheumatic diseases (RD), particularly ANCA-associated vasculitis, anti-GBM disease, and systemic lupus erythematosus (SLE) [1]. Bleeding into alveoli causes respiratory distress and impaired gas exchange [2].
Materials and methods
We conducted a retrospective, cross-sectional, single-center study. We included all adult patients (≥18 years old) with DAH related to RD who were admitted to a tertiary care hospital in Mexico City between January 1, 2003, and December 31, 2023.
Results
A total of 73 patients with DAH were included. The median age of the cohort was 30 years (IQR, 23–39 years). Most patients were female (71%). Comorbidities were present in 34 (47%) patients; the most frequent were hypertension, chronic kidney disease, and diabetes.
Discussion
This study provides valuable insight into a group of RD patients with DAH. The main finding shows a high rate of pulmonary infection. Additionally, we found that male sex and the need for IMV were independent factors significantly associated with the presence of infection.
Conclusion
Pulmonary infection is a common complication in patients with RD presenting with DAH. Pulmonary infection should be actively identified through prompt bronchoscopy and BAL, especially in male patients and those requiring IMV and ICU admission.
Citation: Román-Montes CM, Briones-García E, Navarro-Lara SA, Ortiz-Bustamante MA, García-Herrera IP, Guaracha-Basañez GA (2025) Clinical features and pulmonary infections of diffuse alveolar hemorrhage in rheumatic disease patients. PLoS One 20(12): e0339183. https://doi.org/10.1371/journal.pone.0339183
Editor: Ravi Papu Manglani, Sutter Gould Medical Foundation, UNITED STATES OF AMERICA
Received: October 13, 2025; Accepted: December 2, 2025; Published: December 18, 2025
Copyright: © 2025 Román-Montes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data cannot be shared publicly due to the institution’s local bylaws, as it is a public hospital. The data is available through the Institutional Ethics/Data Access Committee of the Salvador Zubirán National Institute of Medical Sciences and Nutrition (contact: its current Chair, Dr. Martha Guevara Cruz, martha.guevarac@incmnsz.mx) for researchers who meet the criteria for accessing confidential data.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
