Postpartum hemoptysis as presenting sign of longstanding vasculitis

We present the case of a 26-year-old postpartum patient who presented with an episode of desaturation and hemoptysis on postpartum day three after an uncomplicated spontaneous vaginal delivery. The patient came to our attention in the postpartum area after she experienced massive hemoptysis and we were called by the obstetric team. The patient was subsequently intubated, mechanically ventilated, and underwent bronchoscopy, demonstrating diffuse alveolar hemorrhage. She was brought to the intensive care unit, placed on high-dose steroids and plasmapheresis was initiated. Her intensive care unit course was complicated by acute respiratory distress syndrome, acute kidney injury and a pulmonary embolism, but she recovered well and was discharged on postpartum day 23. This report describes a rare case of medium vessel vasculitis diagnosed in the peripartum period, and describes the diagnostic dilemmas underlying making a rare diagnosis, and the difficulties initiating appropriate therapy in a postpartum patient.