A Case Report of Pulmonary Vascular Dilation and Multilevel Bronchial Mucosal Bleeding Contributed to Long-term Administration of Sildenafil

Although sildenafil is approved for erectile dysfunction (ED) and pulmonary arterial hypertension (PAH), its association with pulmonary side effect has not been previously reported. This case underscores the potential risk of pulmonary vascular dilation, tortuosity, and airway mucosal bleeding associated with chronic sildenafil administration. This case report describes a 44-year-old male presenting with a 1-year history of cough and productive sputum, which worsened over the past 3 days. The patient reported no smoking history but had been using sildenafil for 7 years to manage ED. Electronic bronchoscopy identified diffuse punctate hemorrhagic spots in the multilevel-bronchial mucosa. Three-dimensional contrast-enhanced CT angiography of the thoracic aorta revealed dilated and tortuous pulmonary bronchial arteries, along with focal dilation of the pulmonary arterioles and venules. After ruling out alternative diagnoses, chronic sildenafil administration was identified as the culprit cause of pulmonary vascular dilation and mucosal bleeding in this patient. At the 6-month follow-up after sildenafil discontinuation, the patient reported complete resolution of cough. Repeat bronchoscopy: No residual hemorrhagic spots in the tracheobronchial mucosa. Clinicians should maintain heightened vigilance for pulmonary vascular dilation and subsequent hemorrhage risk associated with chronic sildenafil use. The diagnosis of pulmonary vascular abnormalities and airway bleeding necessitates explicit consideration of sildenafil exposure in the differential diagnosis.