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This report focuses on the clinical presentation and management of microscopic polyangiitis leading to alveolar hemorrhage.

May 20, 2026

C41-37 From Seronegative to Serious Alveolar Hemorrhage: A Case of Microscopic Polyangiitis

Puntos clave

This report focuses on the clinical presentation and management of microscopic polyangiitis leading to alveolar hemorrhage.
A case study of a 73-year-old woman with a history of inflammatory arthritis presenting with respiratory symptoms and renal dysfunction.
Clinical evaluations included imaging (CT chest), bronchoscopy, renal biopsy, and vasculitis panel testing.
Treatment involved pulse dose steroids, plasma exchange, and rituximab.
Bronchoscopy revealed diffuse alveolar hemorrhage, confirming the severity of the condition.
Renal biopsy showed pauci-immune focal segmental glomerulonephritis associated with myeloperoxidase antibody positivity.
Patient regained renal function and was successfully discharged without supplemental oxygen.

Resumen

Abstract Microscopic polyangiitis (MPA) is one in a group of small and medium vessel vasculitides that can cause both diffuse alveolar hemorrhage (DAH) and glomerulonephritis with an annual incidence of 10 to 20 cases per million. We present a case of a 73-year-old female previously diagnosed with seronegative inflammatory arthritis, who was originally hospitalized with one week of productive cough, chills, and worsening dyspnea. Initial work up was remarkable for white count of 12, hemoglobin of 7.8 from 13.1 six months prior, and creatinine of 2.25 from previously known baseline of 0.6. She was placed on 3 liters of supplemental oxygen and started on empiric antibiotics. Computed tomography (CT) chest was remarkable for moderate to severe infiltrates in the lungs, more pronounced on the right side. She was admitted for treatment of community acquired pneumonia, however due to increasing oxygen requirements on day 3 of her hospital stay, the pulmonary team was consulted and bronchoscopy was planned. A vasculitis panel was sent given her new anemia and worsening kidney function, however before this could return she required emergent intubation with bedside bronchoscopy demonstrating DAH. Renal biopsy demonstrated pauci-immune focal segmental necrotizing and crescentic glomerulonephritis, correlating with the presence of myeloperoxidase antibody confirming the diagnosis of MPA. The patient was treated with pulse dose steroids, emergent plasma exchange, and rituximab. The patient was ultimately discharged on a prolonged prednisone taper, with eventual recovery in her renal function, and plans for rituximab maintenance therapy. She did not require supplemental oxygen at discharge. Our case demonstrates an initial presentation of MPA with DAH, which is present in approximately one third to one half of cases, and also associated with a high mortality of up to 50%. Our case also highlights the importance of maintaining a precise diagnostic schema when approaching patient care. If more attention had been given to our patient’s acute anemia, as well as presence of microscopic hematuria on admission, vasculitic work up may not have been delayed and she may have been initiated on appropriate treatment sooner, as well as avoided an emergent intubation. This abstract is funded by: None

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