An adolescent case of post-ictal diffuse alveolar hemorrhage

초록

Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening condition characterized by bleeding into the alveolar spaces because of damage to the pulmonary microvasculature. While it is commonly associated with autoimmune or coagulation disorders, post-ictal DAH following a generalized tonic-clonic seizure is extremely rare, especially in pediatric populations. We report the case of a previously healthy 13-year-old boy with allergic rhinitis and buckwheat allergy who presented with his first generalized tonic-clonic seizure. Following admission, he developed dyspnea and tachypnea (respiratory rate of 38/min); on hospital day 2, oxygen desaturation (SaO(2) 88%) accompanied by hemoptysis. Laboratory tests showed no evidence of coagulopathy or autoimmune disease. Chest radiography and computed tomography revealed bilateral pulmonary infiltrates consistent with alveolar hemorrhage. Intravenous methylprednisolone (1 mg/kg for 3 days) was administered, resulting in rapid improvement of respiratory symptoms and imaging findings. This case highlights the importance of early clinical suspicion and imaging-based diagnosis of post-ictal DAH, and the necessity of prompt supportive management to achieve favorable outcomes.

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