Hepatitis B-Related Polyarteritis Nodosa Complicated by Pulmonary Hemorrhage

Guo, Xiuping; Gopalan, Ramprasad; Ugbarugba, S; Stringer, Harold G.; Heisler, Michael; Foreman, Marilyn G.; Nzerue, Chike

doi:10.1378/chest.119.5.1608

Cited by 28 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unlike small-vessel vasculitis, the involvement of the lungs in PAN was considered rare [12]. There are only a few reported cases of PAN complicated with pulmonary hemorrhage [13]; moreover, pathologically proven cases are extremely rare [14]. However, Matsumoto et al [15] reported that, among 10 autopsy cases of PAN, bronchial arteritis was present in 70% and alveolar hemorrhage in all.…”

Section: Discussionmentioning

confidence: 99%

An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage

et al. 2010

View full text Add to dashboard Cite

An 80-year-old woman positive for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was admitted with a 3-month history of fever, general malaise, and weight loss, after unsuccessful treatment with antibiotics. Upon admission, her fever persisted, and there was concomitant deterioration of renal function without active urine sediments. Furthermore, she developed hemoptysis, and chest computed tomography (CT) scan revealed bilateral diffuse alveolar hemorrhage. Although a renal biopsy was not performed because of her dementia, we initially suspected microscopic polyangiitis (MPA) on the basis of her clinical course. Because of her poor general condition, she was administered a low dose of prednisolone. Although her fever subsided, she suffered from intractable alveolar hemorrhage and eventually died from respiratory failure. During the autopsy, fibrinoid necrosis was restricted to medium-sized arteries, including the arcuate arteries of the kidneys and the bronchial arteries, without necrotizing crescentic glomerulonephritis and alveolar capillaritis. Therefore, polyarteritis nodosa (PAN) was diagnosed. It is important to distinguish between MPA and PAN because they can lead to life-threatening complications, and their treatment strategies and prognosis are different. When a patient presents with MPO-ANCA, alveolar hemorrhage, and acute renal failure with little evidence of glomerulonephritis, a differential diagnosis of PAN should be made; however, it is difficult to do so without pathological findings. Therefore, pathological examination should be carried out whenever possible.

show abstract

Section: Discussionmentioning

confidence: 99%

An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Multiple organ disease resulting primarily from small‐ and medium‐sized artery alteration is seldom recorded (12). Kidney alteration has mainly been reported to be caused by small intrarenal aneurysms without glomerulitis resulting in increased blood pressure and kidney dysfunction (12). Neurological and gut localizations are rare (12).…”

Section: Clinical Diseasementioning

confidence: 99%

“…Kidney alteration has mainly been reported to be caused by small intrarenal aneurysms without glomerulitis resulting in increased blood pressure and kidney dysfunction (12). Neurological and gut localizations are rare (12). Anecdotal pulmonary vasculitis associated with gas exchange impairment and haemoptysis have been reported (12).…”

Section: Clinical Diseasementioning

confidence: 99%

“…Neurological and gut localizations are rare (12). Anecdotal pulmonary vasculitis associated with gas exchange impairment and haemoptysis have been reported (12).…”

Section: Clinical Diseasementioning

confidence: 99%

“…Regardless of the circumstances, the liver disease may have been previously diagnosed and complete clinical data provided or, acute or chronic hepatitis may have failed to be previously diagnosed. Anaesthetic assessment will therefore have to: (a) investigate the degree of viral liver injury; (b) systematically check accompanying non‐liver pathologies likely to complicate acute or chronic hepatitis; (c) evaluate side‐effects resulting from specific drug therapy; and (d) disregard any treatment likely to worsen a stabilized liver disease (1–3, 10–20). Additionally, prevention of viral hepatitis nosocomial transmission remains a constant concern for anaesthetists in their daily clinical practice (21).…”

mentioning

confidence: 99%

See 2 more Smart Citations