[An autopsy case of MPO-ANCA-positive microscopic polyangiitis with manifestations of pulmonary hemorrhage and diffuse alveolar damage].
A 68-year-old woman was admitted to our hospital because of fever of unknown origin and pain in the lower extremities. Six weeks after onset, diffuse infiltrative shadows were observed on chest X-ray films, and marked hypoxemia and progressive renal dysfunction suddenly developed. Corticosteroid therapy (2 courses of pulse therapy, each consisting of methylprednisolone at 500 mg/day for 3 days) was not effective, and the patient died 9 weeks after onset because of respiratory failure. Serologic tests were positive for MPO-ANCA. Histopathologic findings at autopsy disclosed arteriolar fibrinoid necrosis in tissues of the liver, spleen, lungs, and kidneys, thus yielding a diagnosis of microscopic polyangiitis. Lung specimens also demonstrated massive alveolar hemorrhaging in the mid-lung fields and diffuse alveolar damage (DAD) in all lobes. Pulmonary hemorrhage coexistent with DAD worsens the prognosis for microscopic polyangiitis in patients positive for MPO-ANCA.
Nakajima
T
T
Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan.
Yasuba
H
H
Yamashita
K
K
Kita
H
H
Sumitomo
S
S
Nakata
K
K
Kato
M
M
D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D009195:Peroxidase / Q000276:immunology*; D011650:Pulmonary Alveoli / Q000473:pathology*; D014657:Vasculitis / Q000473:pathology*
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D009195:Peroxidase