title: [The acute pulmonary renal syndrome: An unusual presentation of granulomatosis with polyangiitis].
abstract: BACKGROUND
  We report a case of acute pulmonary renal syndrome mimicking septic shock, which led to the diagnosis of granulomatosis with polyangiitis.
  
  
  METHODS
  A 70-year-old man was hospitalized because of acute kidney injury and acute respiratory distress syndrome with diffuse alveolar hemorrhage associated with a serum procalcitonin level of 18 μg/L. Initially, septic shock was suspected and antibiotic therapy was started. The absence of microbiological isolates and the patient's rapid clinical deterioration prompted laboratory testing for autoimmune disease, which confirmed the diagnosis of granulomatosis with polyangiitis. Immunosuppressive therapy was promptly initiated with corticosteroids, cyclophosphamide and several plasma exchanges, which resulted in a rapid clinical improvement and ICU discharge.
  
  
  CONCLUSIONS
  Granulomatosis with polyangiitis is a systemic necrotizing vasculitis with antineutrophil cytoplasmic antibodies, which can present with acute pulmonary renal syndrome, combining acute respiratory distress syndrome and acute kidney injury. This misleading presentation must prompt an autoimmune disease testing in order to yield an early diagnosis of a vasculitis, allowing for timely initiation of immunosuppressive treatment. Serum procalcitonin levels can be markedly elevated and this must not override the possibility of a vasculitis where the patient shows a compatible symptomatology.
authors.affiliation: Département d'anesthésie et de réanimation, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France. Electronic address: francois.malavieille@chu-lyon.fr.
authors.forename: F
authors.initials: F
authors.lastname: Malavieille
authors.affiliation: Département d'anesthésie et de réanimation, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: M
authors.initials: M
authors.lastname: Page
authors.affiliation: Département d'anesthésie et de réanimation, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: C-E
authors.initials: CE
authors.lastname: Ber
authors.affiliation: Département d'anesthésie et de réanimation, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: F
authors.initials: F
authors.lastname: Christin
authors.affiliation: Anesthésie-réanimation chirurgicale et surveillance continue, hôpital de la Croix-Rousse, hospices civils de Lyon, bâtiment R, niveau 2, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonnet
authors.affiliation: Département d'anesthésie et de réanimation, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: T
authors.initials: T
authors.lastname: Rimmele
mesh_terms: D000368:Aged; D005921:Glomerulonephritis / Q000209:etiology*; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008297:Male
keywords: Acute kidney injury; Acute respiratory distress syndrome; Granulomatose avec polyangéite; Granulomatosis with polyangiitis; Insuffisance rénale aiguë; Procalcitonin; Procalcitonine; Pulmonary renal syndrome; Syndrome de détresse respiratoire aiguë; Syndrome pneumo-rénal