Fatal Pulmonary Hemorrhage in a Patient with Anca Positive Vasculitis

A 58-year-old, non-smoker man without a medical history presented to emergency department with fatigue, bimalleolar petechiae and renal failure. On admission he was anuric and laboratory findings were urea 244 mg/ dl, creatinine 5.15 mg/dl and GFR 12 ml/min/1.73m2. A central catheter was placed and intermittent hemodialysis therapy was started. Autoimmune blood tests and renal biopsy specimen revealed crescentic glomerulonephritis with PR3-ANCA/C-ANCA positivity. Intravenous cyclophosphamide (12 mg/kg) and pulse steroid therapy (1 gr methylprednisolone) was given. At the 3rd day of the therapy, sudden dyspnea, haemoptysis and a fall in haemoglobin (8.1 gr/dl to 6.3 gr/dl) occurred. Blood gas analysis revealed Ph 7.03, PaO2 of 25 mm Hg, PaCO2 of 61 mm Hg, Lactate 8.28 mmol/L on 100% oxygen mask and he was intubated. Intense hemorrhagic secretion was observed. Chest radiograph revealed a newly formed and sharply delineated right upper lobe infiltration (Figure 1A). Thorax CT and chest radiograph taken the day before showed no abnormalities (Figure 1B,C). Unfortunately