Life-threatening diffuse alveolar hemorrhage associated with Rhinovirus infection and the potential role of corticosteroids in immunocompetent patients

RATIONALE: Diffuse alveolar hemorrhage (DAH) is a rare but potentially fatal condition characterized by bleeding into alveolar spaces, most often associated with autoimmune disease or severe infection. Rhinovirus is a common cause of upper respiratory tract infection but is rarely associated with DAH in immunocompetent individuals. We report 2 cases of life-threatening DAH associated with rhinovirus infection, both presenting with severe hypoxemia and showing marked improvement following corticosteroid therapy. PATIENT CONCERNS: Case 1: An 85-year-old woman presented with massive hemoptysis, dyspnea, and hypoxemia. Chest computed tomography (CT) revealed diffuse ground-glass opacities (GGOs) and patchy consolidations. Case 2: A 70-year-old woman developed worsening dyspnea and hemoptysis despite antibiotics. She was hypoxemic, and chest CT showed bilateral GGOs and consolidations. DIAGNOSES: Bronchoalveolar lavage fluid demonstrated progressively hemorrhagic aliquots consistent with DAH in both cases. Multiplex viral polymerase chain reaction identified rhinovirus as the sole pathogen in both cases, and autoimmune serologic tests were negative. INTERVENTIONS: Both patients received high-flow oxygen therapy, empirical antibiotics, and systemic corticosteroids (Case 1: intravenous methylprednisolone 1 mg/kg/day; Case 2: intravenous methylprednisolone 500 mg/day for 3 days, followed by tapering). OUTCOMES: After corticosteroid therapy, both patients showed rapid clinical and radiographic improvement, with resolution of hypoxemia and discharge within 10 days. LESSONS: These cases suggest a potential association between rhinovirus infection and life-threatening DAH in immunocompetent patients. Both patients showed marked clinical improvement after corticosteroid therapy, suggesting a potential therapeutic role for systemic corticosteroids. Thus, clinicians should consider rhinovirus infection as a possible infectious trigger of DAH, and systemic corticosteroids may be considered in selected severe cases.