Severe autoimmune diffuse alveolar hemorrhage in children; early diagnosis and initiation of therapeutic plasma exchange may improve clinical outcomes

Introduction: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening pulmonary complication in children, presenting with hemoptysis, anemia, diffuse infiltrates, and respiratory failure. Autoimmune diseases such as systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (AAV) account for 30%-40% of pediatric DAH cases. Pediatric evidence is limited to case reports and small series. We aimed to characterize the clinical course, management, and outcomes of pediatric patients with autoimmune DAH requiring intensive care. Methods: We conducted a retrospective cohort study at a single tertiary pediatric institution, identifying 6 patients admitted to the ICU from 2013 to 2024 with DAH secondary to SLE or AAV. Results: sepsis post-decannulation. The remaining patients survived to discharge. Conclusion: Autoimmune DAH in pediatric patients carries high morbidity, often requiring advanced respiratory support and multimodal immunosuppression. Early diagnostics work up and initiation of TPE may improve outcomes. Further prospective pediatric study would be necessary to guide standardized treatment protocols.