A case of microscopic polyangiitis with diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis

Abstract

Vasculitis is a rare but important cause of diffuse alveolar hemorrhage (DAH) and should be considered in the differential diagnosis of patients who develop rapidly progressive dyspnea with nonresolving alveolar opacities on thoracic imaging. The coexistence of renal impairment is termed pulmonary-renal syndrome. Microscopic polyangiitis is a nongranulomatous necrotizing systemic vasculitis that affects arterioles and capillaries. We present a case of a 25-year-old female with hemoptysis with bilateral perihilar chest infiltrates and rapidly deteriorating renal function. Positive anti-myeloperoxidase antibodies, presence of significant hemoptysis, parahilar lung infiltrates, and rapidly deteriorating renal function clinched the diagnosis of DAH secondary to small-vessel vasculitis (microscopic polyangiitis). The patient showed significant improvement with hemodialysis, oxygen supplementation, steroids, and cyclophosphamide. Hemoptysis with rapidly deteriorating renal function in a young to middle-aged lady should raise suspicion of underlying vasculitis after ruling out other more common causes.

Keywords

• anti-myeloperoxidase antibodies
• diffuse alveolar hemorrhage
• microscopic polyangiitis
• vasculitis