Recombinant activated factor VII for diffuse alveolar hemorrhage in microscopic polyangiitis

Diffuse alveolar hemorrhage is a serious complication of the small vessel vasculitis syndromes and carries a high mortality. Recombinant activated factor VII (rFVIIa) is a powerful hemostatic agent developed for treatment of bleeding in patients with hemophilia and antibodies to factors VIII or IX. It has been used increasingly in life-threatening hemorrhage in a variety of other settings in which conventional medical or surgical therapy is unsuccessful. We report the successful use of rFVIIa for massive pulmonary hemorrhage in a patient of microscopic polyangiitis, which was later complicated by thrombotic microangiopathy and posterior reversible encephalopathy syndrome.