RESEARCH ARTICLE


A Case of Pulmonary Hemorrhage and Renal Failure



Alexa S. Meara1, *, Daphne M. Harrington1, Jennifer Foster2, Tushar J. Vachharajani3 , Tejas Desai4
1 Division of General Internal Medicine, Department of Internal Medicine, The Brody School of Medicine at East Carolina University, USA
2 Cleveland Clinic Florida – Weston, 2950 Cleveland Clinic Blvd.,Weston, FL 33331, USA
3 Nephrology Section, W. G. (Bill) Hefner VA Medical Center, Salisbury, NC, USA
4 Division of Nephrology and Hypertension, Department of Internal Medicine, The Brody School of Medicine at East Carolina University, USA


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© Meara et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at Department of Internal Medicine, Brody School of Medicine at ECU, 600 Moye Blvd, VMC MA-350, Greenville, NC 27834, USA; Tel: 52-744-4555; E-mail: simona@ecu.edu


Abstract

Background:

Alveolar hemorrhage can be seen in many vasculitic disorders. However, granulomatosis polyangiitis (formerly Wegener’s granulomatosis) uncommonly presents with life threatening alveolar hemorrhage and has only been discussed in a few case reports [1].

Case Presentation:

A 53 year old Caucasian male presented with hemoptysis and profound anemia. Two weeks prior, he had presented with abdominal pain with normal renal function and numerous pulmonary nodules. During the current admission, the patient was hypoxic with acute renal failure requiring hemodialysis. Urine sediment demonstrated dysmorphic red blood cells. A bronchoscopy revealed diffuse alveolar hemorrhage. The diagnosis of pulmonary-renal syndrome was made and therapeutic plasma exchange was initiated. Laboratory studies were significant for a c-ANCA titer positive at 1:640 FIU and anti-proteinase (PR)-3 antibody titer positive with 78.3 U/ml. Renal biopsy demonstrated necrotizing crescentic glomerulonephritis. A diagnosis of granulomatosis vasculitis was determined.

Conclusion:

Alveolar hemorrhage is rare to be the presenting symptom of granulomatosis vasculitis where the common presenting features are recurrent sinusitis, epistaxis, chronic otitis media or rhinitis. Physicians should consider granulomatosis vasculitis in the differential diagnosis of pulmonary-renal syndrome presenting with hemoptysis.

Keywords : Granulomatosis, vasculitis, pulmonary hemorrhage, renal insufficiency, Wegener’s, dialysis, plamapharesis..