Recurrent diffuse alveolar haemorrhage in a patient receiving dialysis

We report a case of a man in his 80s undergoing maintenance dialysis who developed recurrent diffuse alveolar haemorrhage (DAH). Initially, he presented with acute respiratory failure requiring non-invasive positive pressure ventilation. He responded to high-dose steroid therapy, which was tapered over 1 year. After discontinuation, he developed recurrent DAH requiring intubation and mechanical ventilation. Chest CT revealed bilateral ground-glass opacities, and bronchoscopy confirmed alveolar haemorrhage. Restarting steroid therapy along with cessation of low-dose aspirin led to rapid improvement. Given his high cardiovascular risk, low-dose aspirin was cautiously resumed during hospitalisation under low-dose steroid maintenance. No recurrence has been observed to date. This case highlights the importance of individualised antithrombotic management in dialysis patients and suggests the potential contribution of low-dose aspirin to DAH.