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A 73-Year-Old Man With Refractory Hemoptysis.
Hiroshi Kobe1, Masashi Momose1, Yui Miyazaki1
1Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
Chest
|October 9, 2022
Summary
A 73-year-old man with fever, fatigue, and worsening renal function was initially treated for pneumonia. Further tests revealed elevated myeloperoxidase-anti-neutrophil cytoplasmic antibodies, indicating microscopic polyangiitis (MPA).
Area of Science:
- Nephrology
- Pulmonology
- Rheumatology
Background:
- A 73-year-old male with a history of smoking and COPD presented with fever and fatigue.
- Initial chest CT revealed an infiltrative shadow in the left lower lobe.
- Treatment for community-acquired pneumonia with broad-spectrum antibiotics yielded no improvement.
Observation:
- The patient experienced rapid deterioration of renal function, with creatinine rising to 2.08 mg/dL.
- Laboratory findings included elevated myeloperoxidase-anti-neutrophil cytoplasmic antibodies (484.0 U/mL), high C-reactive protein (11.1 mg/dL), and anemia (hemoglobin 9.0 g/dL).
- Physical examination revealed purpuric lesions and hemoptysis.
Findings:
- Diagnosis of microscopic polyangiitis (MPA) was suspected due to clinical presentation and laboratory results, particularly positive MPO-ANCA.
- Despite initial high-dose methylprednisolone treatment, hemoptysis recurred, necessitating further medical intervention.
Implications:
- This case highlights the importance of considering systemic vasculitis in patients with unexplained renal dysfunction and pulmonary symptoms.
- Early and accurate diagnosis of MPA is crucial for effective management and prevention of severe complications.
- Further investigation into the patient's condition and treatment response is warranted.
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