Alveolar hemorrhage, skin eruption, and gastrointestinal bleeding accompanied by crescentric glomerulonephritis in a patient with cytoplasmic anti-neutrophil cytoplasmic antibody

Abstract

A 69-year-old woman was admitted to our hospital because of hemoptysis, skin eruption, and gastrointestinal bleeding. A chest X-ray film revealed infiltrates in the left upper lung field. Analysis of bronchoalveolar lavage fluid revealed alveolar hemorrhage. Examination of skin biopsy specimens demonstrated leukocytoclastic vasculitis. Fiberoptic examination of the colon showed diffuse reddish and edematous mucosa. Histological examination of biopsy specimens from the sigmoid colon showed necrotizing vasculitis. The serum creatinine level was high: 2.2 mg/dl. Examination of transcutaneous renal biopsy specimens revealed crescentric glomerulonephritis. A test for perinuclear anti-neutrophil cytoplasmic antibody was negative, but a test for cytoplasmic anti-neutrophil cytoplasmic antibody was positive. The latter strongly suggests a diagnosis of Wegener's granulomatosis, although the association is not absolute. We diagnosed pulmonary-renal syndrome associated with anti-neutrophil cytoplasmic antibody. The findings in this case were compatible with microscopic polyangiitis.