Diffuse Alveolar Haemorrhage — DCE Clinical Case

Focused history — what you must establish

• The respiratory trajectory: onset and progression of dyspnoea, cough, haemoptysis (volume, frequency), exertional tolerance, and any preceding 'sinusitis' or 'pneumonia' that failed antibiotics — the failed-treatment story is the vasculitis signature ^[1].
• Upper-airway and systemic features: nasal crusting, bloody discharge, saddle-nose change, hearing loss, ear pain; fevers, weight loss, night sweats; rash; joint pains; eye symptoms; numbness or foot-drop (mononeuritis).
• Bleeding modifiers: anticoagulants, antiplatelets, NSAIDs; occupational exposures — as a gardener, hydrocarbon and solvent exposure matters because such exposures unmask the alveolar epitope in anti-GBM disease ^[7].
• Renal clues: frothy urine, dark or cola-coloured urine, nocturia, ankle swelling; baseline creatinine and prior urine results.
• The patient's frame: what he thinks is wrong, what he fears, his work and family situation — a long case is a person, not a syndrome.