title: Acute diffuse interstitial fibrosing pneumonitis and bilateral renal cortical necrosis.
abstract: An autopsy case of a 69-year-old male with acute diffuse interstitial fibrosing pneumonitis complicated by bilateral renal cortical necrosis was presented. Autopsy revealed acute diffuse interstitial fibrosing pneumonitis, bilateral renal cortical necrosis, non-bacterial thrombotic endocarditis, involving the aortic and mitral valves, and some interesting vascular lesions, dissemination of fibrinoid change of arterioles and fibrin thrombus of small vessels in various organs; accumulation of polymorphonuclear leukocytes in the lumen of the smaller interlobular arteries and arterioles of the kidney with cellular infiltration and disintegration of the wall; severe disorganization of the wall with intraluminar and intramural fibrinous exudation in smaller branches of the hepatic artery; diminution and disarrangment of muscle fibers and patchy hyalinization in the media of the renal and interlobar arteries. The inter-relationship between acute diffuse interstitial fibrosing pneumonitis, bilateral renal cortical necrosis which may be regarded as a 'hallmark' of the generalized Shwartzman reaction, and disseminated intravascular coagulation was discussed.
mesh_terms: D000208:Acute Disease; D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D006801:Humans; D007668:Kidney / Q000473:pathology; D007673:Kidney Cortex Necrosis / Q000209:etiology / Q000473:pathology*; D008168:Lung / Q000473:pathology; D008297:Male; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000473:pathology*; D012790:Shwartzman Phenomenon / Q000150:complications