title: A Rare Clinical Course of Seronegative Pulmonary-Renal Syndrome.
abstract: Purpose. Pulmonary-renal syndrome (PRS) is characterized by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis mainly due to autoimmune etiologies. Seronegative PRS is a challenging entity to the clinician, since early diagnosis may be missed leading to delayed appropriate treatment.Materials and Methods. We present the clinical course of a 77-year-old patient who was admitted under the suspected diagnosis of pneumogenic sepsis and septic renal failure with fever, dyspnea, and elevated CRP levels. The diagnosis of pulmonary-renal syndrome was initially missed because of the absence of autoantibodies in all serological findings.Results.Despite delayed initiation of immunosuppressive therapy and a prolonged period of dialysis and extracorporeal membrane oxygenation the patient recovered well and was released to a rehabilitation center with nearly normalized creatinine levels. The diagnosis of PRS was established by renal biopsy.Conclusion. This case illustrates the important differential diagnosis of seronegative pulmonary-renal syndrome in patients with pulmonary and renal impairment.
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: M
authors.identifier: 0000-0001-8046-9893
authors.initials: M
authors.lastname: Fröhlich-Gildhoff
authors.affiliation: Department of Nephrology, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: W J
authors.initials: WJ
authors.lastname: Jabs
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Berhold
authors.affiliation: Department of Nephrology, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: M K
authors.initials: MK
authors.lastname: Kuhlmann
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Ketterer
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kische
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Ince