title: Diffuse alveolar hemorrhage emerging one week after starting high-dose corticosteroid therapy for granulomatosis with polyangiitis (GPA) with systemic lupus erythematosus (SLE).
abstract: A 69-year-old man was diagnosed with granulomatosis with polyangiitis (GPA) based on the presence of skin granuloma, refractory otitis media, renal insufficiency and myeloperoxidase-antineutrophil cytoplasmic antibody positivity and slight lung opacity. He was treated with high-dose corticosteroid therapy. Despite the initial improvement of his renal function and a decrease in his C-reactive protein level, he suffered from an alveolar hemorrhage one week after the start of corticosteroid therapy. An anti-dsDNA antibody test was positive and the patient had hypocomplementemia. Elements of both GPA and systemic lupus erythematosus were thought to have affected his clinical course.
authors.affiliation: Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Fukui
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Sosuke
authors.initials: S
authors.lastname: Tsuji
authors.forename: Masataka
authors.initials: M
authors.lastname: Umeda
authors.forename: Ayako
authors.initials: A
authors.lastname: Nishino
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Takahisa
authors.initials: T
authors.lastname: Suzuki
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Horai
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Koga
authors.forename: Shin-Ya
authors.initials: SY
authors.lastname: Kawashiri
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ichinose
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Hirai
authors.forename: Mami
authors.initials: M
authors.lastname: Tamai
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007677:Kidney Function Tests; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D009195:Peroxidase; D011650:Pulmonary Alveoli
chemical_list: D000305:Adrenal Cortex Hormones; D002097:C-Reactive Protein; D009195:Peroxidase