{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:27:47Z","timestamp":1772648867567,"version":"3.50.1"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:p>Hemoptysis secondary to diffuse alveolar hemorrhage (DAH) is uncommon in children. When it does occur, extensive investigations are often required to determine the underlying cause. We present a unique case of a 17-year-old previously healthy male adolescent with a history of allergic rhinitis, who initially presented with pneumonia in the setting of influenza A. He subsequently developed DAH, prompting further diagnostic evaluations that ultimately revealed a rare condition with long-term morbidity.<\/jats:p>","DOI":"10.1542\/peds.2025-073274","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:02:25Z","timestamp":1771545745000},"source":"Crossref","is-referenced-by-count":0,"title":["A Bloody Cough and Clouded Lungs: Uncovering a Systemic Culprit in an Adolescent"],"prefix":"10.1542","volume":"157","author":[{"given":"Christina","family":"Wells","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, Downstate Medical Center, State University of New York, Brooklyn, New York"},{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyung-Gyo","family":"Cho","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Downstate Medical Center, State University of New York, Brooklyn, New York"},{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai Sravya","family":"Gude","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Downstate Medical Center, State University of New York, Brooklyn, New York"},{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Disi","family":"Chen","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Downstate Medical Center, State University of New York, Brooklyn, New York"},{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nutchaya","family":"Amornruk","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Downstate Medical Center, State University of New York, Brooklyn, New York"},{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Cheng","sequence":"additional","affiliation":[{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ratna","family":"Basak","sequence":"additional","affiliation":[{"name":"2NYC Health\u2009+\u2009Hospitals\/Kings County, Brooklyn, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"issue":"6","key":"2026030411172270900_r1","first-page":"766","article-title":"Fatal influenza B-MRSA coinfection in a healthy adolescent: necrotizing pneumonia, cytokine storm, and multi-organ failure","volume":"12","author":"Profir","year":"2025","journal-title":"Children (Basel)."},{"issue":"6","key":"2026030411172270900_r2","doi-asserted-by":"crossref","first-page":"894","DOI":"10.3201\/eid1206.051141","article-title":"Severe community-acquired pneumonia due to Staphylococcus aureus, 2003\u201304 influenza season","volume":"12","author":"Hageman","year":"2006","journal-title":"Emerg Infect Dis."},{"key":"2026030411172270900_r3","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3389\/fped.2017.00170","article-title":"Pulmonary embolism in children","volume":"5","author":"Zaidi","year":"2017","journal-title":"Front Pediatr."},{"issue":"12","key":"2026030411172270900_r4","doi-asserted-by":"crossref","first-page":"3246","DOI":"10.1097\/CCM.0b013e318260c7f8","article-title":"Coinfection with Staphylococcus aureus increases risk of severe coagulopathy in critically ill children with influenza A (H1N1) virus infection","volume":"40","author":"Nguyen","year":"2012","journal-title":"Crit Care Med."},{"issue":"4","key":"2026030411172270900_r5","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1001\/archotol.127.4.377","article-title":"Etiology and management of pediatric hemoptysis","volume":"127","author":"Batra","year":"2001","journal-title":"Arch Otolaryngol Head Neck Surg."},{"issue":"1","key":"2026030411172270900_r6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13256-025-05084-7","article-title":"Systematic review of case series and case reports on pediatric pulmonary embolism","volume":"19","author":"Alsabri","year":"2025","journal-title":"J Med Case Rep."},{"issue":"1","key":"2026030411172270900_r7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s12969-025-01149-5","article-title":"New avenues in childhood vasculitis","volume":"23","author":"Ercan Emreol","year":"2025","journal-title":"Pediatr Rheumatol Online J."},{"issue":"1","key":"2026030411172270900_r8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/art.37715","article-title":"2012 revised international Chapel Hill consensus conference nomenclature of vasculitides","volume":"65","author":"Jennette","year":"2013","journal-title":"Arthritis Rheum."},{"key":"2026030411172270900_r9","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3389\/fped.2020.00281","article-title":"Clinical perspective on primary angiitis of the central nervous system in childhood (cPACNS)","volume":"8","author":"Smitka","year":"2020","journal-title":"Front Pediatr."},{"key":"2026030411172270900_r10","first-page":"209","article-title":"Cavitary tuberculosis re-emerging in immigrant children","volume":"26","author":"Perdikogianni","year":"2019","journal-title":"Respir Med Case Rep."},{"issue":"6","key":"2026030411172270900_r11","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1001\/archpedi.160.6.596","article-title":"Symptomatic children with hereditary hemorrhagic telangiectasia: a pediatric center experience","volume":"160","author":"Mei-Zahav","year":"2006","journal-title":"Arch Pediatr Adolesc Med."},{"issue":"4","key":"2026030411172270900_r12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/SMJ.0b013e3182126d3b","article-title":"Diffuse alveolar hemorrhage","volume":"104","author":"Newsome","year":"2011","journal-title":"South Med J."},{"issue":"4","key":"2026030411172270900_r13","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/jth.12155","article-title":"Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines","volume":"11","author":"Wada","year":"2013","journal-title":"J Thromb Haemost."},{"issue":"4","key":"2026030411172270900_r14","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/S0002-9343(03)00359-0","article-title":"Churg-Strauss syndrome: clinical presentation, antineutrophil cytoplasmic antibodies, and leukotriene receptor antagonists","volume":"115","author":"Keogh","year":"2003","journal-title":"Am J Med."},{"issue":"6","key":"2026030411172270900_r15","doi-asserted-by":"crossref","first-page":"488","DOI":"10.7326\/0003-4819-116-6-488","article-title":"Wegener granulomatosis: an analysis of 158 patients","volume":"116","author":"Hoffman","year":"1992","journal-title":"Ann Intern Med."},{"issue":"3","key":"2026030411172270900_r16","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/1529-0131(199904)42:3<421::AID-ANR5>3.0.CO;2-6","article-title":"Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients","volume":"42","author":"Guillevin","year":"1999","journal-title":"Arthritis Rheum."},{"issue":"9","key":"2026030411172270900_r17","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1002\/acr.24590","article-title":"Consensus treatment plans for severe pediatric antineutrophil cytoplasmic antibody-associated vasculitis","volume":"74","author":"Morishita","year":"2022","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"3S","key":"2026030411172270900_r18","first-page":"S71","article-title":"KDIGO 2024 clinical practice guideline for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) ANCA Vasculitis Work Group","year":"2024","journal-title":"Kidney Int."},{"issue":"8","key":"2026030411172270900_r19","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1002\/art.41773","article-title":"2021 American College of Rheumatology\/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis","volume":"73","author":"Chung","year":"2021","journal-title":"Arthritis Rheumatol."},{"issue":"4","key":"2026030411172270900_r20","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/rheumatology\/keaa057","article-title":"European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides\u2014the SHARE initiative","volume":"59","author":"de Graeff","year":"2020","journal-title":"Rheumatology (Oxford)."},{"issue":"10","key":"2026030411172270900_r21","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1056\/NEJMoa2311155","article-title":"Benralizumab versus mepolizumab for eosinophilic granulomatosis with polyangiitis","volume":"390","author":"Wechsler","year":"2024","journal-title":"N Engl J Med."},{"issue":"1","key":"2026030411172270900_r22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/art.41901","article-title":"Phase IIa global study evaluating rituximab for the treatment of pediatric patients with granulomatosis with polyangiitis or microscopic polyangiitis","volume":"74","author":"Brogan","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"2026030411172270900_r23","article-title":"Rituxan prescribing information","author":"US Federal Drug Administration","year":"2021"},{"issue":"12","key":"2026030411172270900_r24","first-page":"1767","article-title":"The efficacy and safety of rituximab in ANCA-associated vasculitis: a systematic review","volume":"11","author":"Habibi","year":"2022","journal-title":"Biology (Basel)."},{"issue":"8","key":"2026030411172270900_r25","first-page":"544","article-title":"Preparing for biologic or immunosuppressant therapy","volume":"7","author":"Kane","year":"2011","journal-title":"Gastroenterol Hepatol (N Y)."},{"issue":"12","key":"2026030411172270900_r26","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1002\/art.40577","article-title":"Epidemiology and outcomes of granulomatosis with polyangiitis in pediatric and working-age adult populations in the United States: analysis of a large national claims database","volume":"70","author":"Panupattanapong","year":"2018","journal-title":"Arthritis Rheumatol."},{"issue":"Suppl 103(1","key":"2026030411172270900_r27","first-page":"202","article-title":"Clinical course and outcomes of childhood-onset granulomatosis with polyangiitis","volume":"35","author":"James","year":"2017","journal-title":"Clin Exp Rheumatol."},{"issue":"4","key":"2026030411172270900_r28","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1002\/ppul.26301","article-title":"Diffuse alveolar hemorrhage in children with interstitial lung disease: determine etiologies!","volume":"58","author":"Knoflach","year":"2023","journal-title":"Pediatr Pulmonol."},{"issue":"5","key":"2026030411172270900_r29","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/rheumatology\/keh548","article-title":"Impairment of lung function, health status and functional capacity in patients with ANCA-associated vasculitis","volume":"44","author":"Newall","year":"2005","journal-title":"Rheumatology (Oxford)."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073274\/1911924\/pediatrics.2025073274.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073274\/1911924\/pediatrics.2025073274.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:17:31Z","timestamp":1772641051000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/157\/3\/e2025073274\/206434\/A-Bloody-Cough-and-Clouded-Lungs-Uncovering-a"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2,20]]},"published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-073274","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"article-number":"e2025073274"}}