title: Granulomatosis with polyangiitis presenting with diffuse alveolar hemorrhage requiring extracorporeal membrane oxygenation with rapid multiorgan relapse: A case report.
abstract: BACKGROUND
  Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmatic antibodies (ANCA)-associated vasculitis affecting small- and medium-sized blood vessels, mostly involving lung and kidney.
  
  
  METHODS
  We report the case of a 33-year-old man that presented with acute respiratory distress syndrome caused by alveolar hemorrhage.
  
  
  METHODS
  Aggressive GPA presenting with diffuse alveolar hemorrhage and multiorgan involvement.
  
  
  METHODS
  Immunosuppressive therapy, plasma exchange, extracorporeal membrane oxygenation (ECMO).
  
  
  RESULTS
  Relapse occurred very early, despite immunosuppressive treatment, with a rare involvement of genital system (epididymitis) and rapidly progressive glomerulonephritis difficult to treat.
  
  
  CONCLUSIONS
  GPA is a challenging, multifaceted disease that can require aggressive supportive therapy and is associated with a high rate of relapse that may present with uncommon site of involvement.
authors.affiliation: Divisione di Clinica Medica Divisione di Anestesia e Rianimazione Divisione di Radiologia Divisione di Anatomia Patologica, Ospedale San Gerardo, Monza University of Milano-Bicocca and Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni, Milano, Italy.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vanoli
authors.forename: Marta
authors.initials: M
authors.lastname: Riva
authors.forename: Beatrice
authors.initials: B
authors.lastname: Vergnano
authors.forename: Gabriele
authors.initials: G
authors.lastname: D'Andrea
authors.forename: Vincenzo
authors.initials: V
authors.lastname: L'Imperio
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pozzi
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D014890:Granulomatosis with Polyangiitis / Q000150:complications*; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male