Wegener’s Granulomatosis Treatment with Heparin in Addition to Azathioprine and Corticosteroids

Abstract

A case of Wegener’s granulomatosis in a 51-year-old white male is described. His initial clinical course was characterized by severe renal and pulmonary insufficiency. Renal biopsy showed severe proliferative glomerulonephritis with crescent formation plus intraglomerular fibrin deposition. Because of the seriousness of the renal lesion along with the demonstrated fibrin deposition, the patient was treated with heparin in addition to azathioprine and methylprednisolone. A prompt improvement in renal function was noted following heparin administration. After 9 months, heparin was stopped while azathioprine and prednisolone were continued. Renal function deteriorated and then improved after reinstitution of heparin therapy. The initial chest roentgenogram and pulmonary function tests were compatible with Goodpasture’s syndrome. Nine months later, however, the more classic picture of basilar cavitary lesions appeared.