xpectoration of blood (hemoptysis) is a serious albeit non-specific, pulmonary symptom that deserves a thorough diagnostic work-up. 1 Patients with diffuse alveolar hemorrhage (DAH) presenting usually with hemoptysis pose a real diagnostic challenge for the treating physician because of the heterogenous etiologies involved. 2 In the case presented, a relatively rare cause of pulmonary hemorrhage (antiphospholipid syndrome) was reached after exhaustive investigations. In the antiphospholipid syndrome, DAH leading to acute respiratory failure is a rather unusual complication of the syndrome, making it is possible that the diagnosis is overlooked or its manifestations are attributed to another disease. 3 The primary type of antiphospholipid syndrome (APS) (i.e. without underlying disease e.g. systemic lupus erythematosis) is now recognized to be much more common than the secondary type. It is characterized by widespread E venous and arterial thrombosis predisposed by the presence of antiphospholipid antibodies. 4 As in the case presented, a patient with primary APS may develop massive pulmonary hemorrhage leading to respiratory failure. However the response to high- dose intravenous glucocorticosteroid treatment was dramatic. Case Report. A 27 year-old Saudi non-smoker, single female was referred and admitted electively for the work-up of hemoptysis. Her first episode occurred 2 years before this presentation, and was followed by recurrent hemoptysis of variable amounts of 10-50 cc of fresh blood. Eleven months before presentation she had deep vein thrombosis in the left lower limb then in the right lower limb. There was a history of mild shortness of breath but no chest pain, joint pains, hematemesis or melena. Massive pulmonary hemorrhage in a Saudi female with primary antiphospholipid syndrome Mohamed S. Al-Hajjaj, FRCP(C), FCCP. From the Medical Department, College of Medicine, King Saud Unversity, Riyadh, Kingdom of Saudi Arabia. Received 26th February 2000. Accepted for publication in final form 26th April 2000. Address correspondence and reprint request to: Dr Mohamed S. Al-Hajjaj, Associate Professor & Consultant Pulmonologist, Medical Department (38), College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Tel. +966 1 467 1528. Fax: +966 1 467 9496. E- mail: mshajjaj@ksu.edu ABSTRACT 777 The antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies and the association of protean clinical manifestations as a result of both venous and arterial thrombosis. Because diffuse alveolar hemorrhage leading to acute respiratory failure is a rather unusual complication of antiphospholipid antibodies, this diagnosis may be overlooked or its manifestations are attributed to another disease. Presented here is a young Saudi female with primary antiphospholipid syndrome who recovered after a stormy clinical course of acute respiratory failure in the intensive care unit. Keywords: Antiphospholipid, alveolar, hemorrhage, respiratory failure. Saudi Medical Journal 2000; Vol. 21 (8): 777-779 Case Report