[Microscopic polyangiitis and pulmonary fibrosis in a patient who died of Candida pneumonia and intra-alveolar hemorrhage].
H KishikawaH TojimaT TokudomePublished in: Nihon Kyobu Shikkan Gakkai zasshi (1998)
A 74-year-old man was admitted to our hospital because of edema of the lower legs, fever, and increasing fatigue. Laboratory evaluation revealed proteinuria, microhematuria, leukocytosis, thrombocytosis, anemia, a high level of C-reactive protein. A test for myeloperoxidase-antineutrophil cytoplasmic antibodies was highly positive. Microscopic polyarteritis nodosa was diagnosed and therapy with prednisolone was begun. Examination of a renal biopsy sample showed necrotizing crescentic glomerulonephritis. A chest roentgenogram and CT scan disclosed bilateral basilar interstitial changes. Six months later, the patient was admitted again because of disturbance of consciousness, malnutrition, and hyponatremia. After admission, alveolar infiltrates developed in the right lung and the patient died on the 5th hospital day as a result of respiratory failure. An autopsy revealed Candida pneumonia of the right lung and massive intra-alveolar hemorrhage, which was believed to have caused the respiratory failure. Other findings were usual interstitial pneumonia, cellular small-vessel angiitis in the lungs, and healed angiitis in the kidneys and liver. In this case of microscopic polyangiitis and chronic interstitial pneumonia, steroid therapy was effective against the angiitis, but the patient died of an opportunistic infection and alveolar hemorrhage.
Keyphrases
- respiratory failure
- case report
- extracorporeal membrane oxygenation
- mechanical ventilation
- computed tomography
- healthcare
- emergency department
- pulmonary fibrosis
- candida albicans
- acute respiratory distress syndrome
- escherichia coli
- heart failure
- bone marrow
- single cell
- stem cells
- physical activity
- community acquired pneumonia
- contrast enhanced
- drug induced
- sleep quality
- acute heart failure
- pet ct