title: Tacrolimus as a reinforcement therapy for a patient with MPO-ANCA-associated diffuse alveolar hemorrhage.
abstract: A 67-year-old woman, suffering from continuous hemoptysis, was admitted to our hospital where she was managed with mechanical ventilation. Computed tomography of the chest demonstrated bilateral massive alveolar hemorrhage without evidence of infectious disease. She was diagnosed with anti-myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated diffuse alveolar hemorrhage because a high titer of MPO-ANCA was found in the serum. Plasmapheresis as well as methylprednisolone pulse therapy were initiated, followed by intravenous administration of cyclophosphamide. Tacrolimus was employed for the maintenance therapy, and the oral prednisolone dosage could successfully be tapered without recurrence, along with the decrement of the titer of MPO-ANCA.
authors.affiliation: The First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Emi
authors.initials: E
authors.lastname: Honda
authors.forename: Nozomi
authors.initials: N
authors.lastname: Iwanaga
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ida
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.forename: Shoko
authors.initials: S
authors.lastname: Honda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Tsuchihashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshimine
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D003131:Combined Modality Therapy; D003520:Cyclophosphamide; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006470:Hemorrhage / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D017563:Lung Diseases, Interstitial / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D009195:Peroxidase / Q000276:immunology; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000473:pathology; D013902:Radiography, Thoracic; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D009195:Peroxidase; D016559:Tacrolimus