Malignant hypertension with an unusual presentation mimicking the immune mediated pulmonary renal syndrome.
A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.
Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, Korea.
Hoon Suk
HS
Park
Yu Ah
YA
Hong
Byung Ha
BH
Chung
Hyung Wook
HW
Kim
Cheol Whee
CW
Park
Chul Woo
CW
Yang
Dong Chan
DC
Jin
Yong Soo
YS
Kim
Bum Soon
BS
Choi
D000328:Adult; D005921:Glomerulonephritis / Q000175:diagnosis*; D006469:Hemoptysis / Q000473:pathology; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis*; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male