Diffuse Alveolar Haemorrhage A Rare Presentation of Infective Endocarditis: A Challenging Case

Abstract Infective endocarditis (IE) is a life-threatening condition that can lead to systemic complications, including diffuse alveolar haemorrhage (DAH), an uncommon but serious pulmonary manifestation. I present a case of a 37-year-old male with a history of smoking, alcohol consumption and prolonged occupational exposure to cotton dust, who presented with prolonged fever, cough, haemoptysis, and dyspnea. Examination revealed clubbing, pedal edema, raised JVP, and coarse crepitations in both lungs. Cardiovascular examination revealed a holosystolic murmur. Blood cultures confirmed the presence of a typical endocarditis-associated microorganism Streptococcus viridans and echocardiography demonstrated vegetations consistent with IE. Bronchoalveolar lavage was sequentially haemorrhagic which showed hemosiderin-laden macrophages, confirming diffuse alveolar haemorrhage. The patient was managed with intravenous antibiotics, supportive therapy and close hemodynamic monitoring. This case highlights the importance of early recognition and aggressive management of infective endocarditis to prevent rare but life-threatening complications.