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Various patterns of acute alveolar haemorrhage in patients with microscopic polyangiitis: a clinicopathological study

Naoto Kuroda, Kenji Yorita, Kei Sakamoto

    Polish Journal of Pathology : Official Journal of the Polish Society of Pathologists
    |February 22, 2019
    PubMed

    Insights

    Acute alveolar haemorrhage (AAH) in microscopic polyangiitis (MPA) can stem from various causes beyond capillaritis. This study highlights infections and other conditions contributing to AAH in MPA patients, all of whom died from respiratory failure.

    Area of Science:

    • Pulmonary Medicine
    • Pathology
    • Rheumatology

    Background:

    • Microscopic polyangiitis (MPA) is a small-vessel vasculitis often associated with acute alveolar haemorrhage (AAH).
    • Traditionally, AAH in MPA is attributed to capillaritis.
    • This study investigates less common causes of AAH in MPA patients.

    Observation:

    • Analysis of four autopsy cases of MPA with AAH.
    • Investigated factors included patient demographics, cause of AAH, treatment, follow-up, and cause of death.
    • All patients received corticosteroid therapy, with one also receiving cyclophosphamide.

    Findings:

    • AAH causes included diffuse alveolar damage (DAD) from candidiasis or influenza, haemorrhagic infarct from aspergillosis, MPA-associated capillaritis, and virus-associated vasculitis (CMV, HSV).
    • All four patients experienced respiratory failure as the cause of death.
    • Follow-up duration ranged from 1 to 26 months (mean 8 months).

    Implications:

    • Clinicians and pathologists must consider diverse etiologies for AAH in MPA.
    • Recognizing causes like DAD, infections, and virus-associated vasculitis is crucial for patient management.
    • This broadens the differential diagnosis for AAH in MPA, potentially improving diagnostic accuracy.
    Keywords:
    microscopic polyangiitisalveolar haemorrhage

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