Diffuse Alveolar Hemorrhage Developing Immediately after Immunosuppressive Treatments in a Patient with Granulomatosis with Polyangiitis Who Had Pulmonary Nodules

Chiaki Watanabe; Shoichi Fukui; Naoki Iwamoto; Toshimasa Shimizu; Masataka Umeda; Ayako Nishino; Tomohiro Koga; Shin-ya Kawashiri; Kunihiro Ichinose; Yasuko Hirai; Mami Tamai; Hideki Nakamura; Tomoki Origuchi; Kazuhiro Tabata; Atsushi Kawakami

doi:10.2169/internalmedicine.9188-17

CASE REPORTS

Diffuse Alveolar Hemorrhage Developing Immediately after Immunosuppressive Treatments in a Patient with Granulomatosis with Polyangiitis Who Had Pulmonary Nodules

Chiaki Watanabe, Shoichi Fukui, Naoki Iwamoto, Toshimasa Shimizu, Masataka Umeda, Ayako Nishino, Tomohiro Koga, Shin-ya Kawashiri, Kunihiro Ichinose, Yasuko Hirai, Mami Tamai, Hideki Nakamura, Tomoki Origuchi, Kazuhiro Tabata, Atsushi Kawakami

Author information

Chiaki Watanabe
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Shoichi Fukui
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Naoki Iwamoto
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Toshimasa Shimizu
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Masataka Umeda
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Ayako Nishino
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tomohiro Koga
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Shin-ya Kawashiri
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Unit of Advanced Preventive Medical Sciences, Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
Kunihiro Ichinose
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Yasuko Hirai
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Mami Tamai
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Hideki Nakamura
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tomoki Origuchi
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Unit of Rehabilitation Sciences, Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Japan
Kazuhiro Tabata
Department of Pathology, Nagasaki University Hospital, Japan
Atsushi Kawakami
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan

Keywords: diffuse alveolar hemorrhage, granulomatosis with polyangiitis, intravenous pulse methylprednisolone, intravenous cyclophosphamide pulse therapy, ANCA associated vasculitis

JOURNAL OPEN ACCESS

2018 Volume 57 Issue 3 Pages 417-421

DOI https://doi.org/10.2169/internalmedicine.9188-17

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Abstract

A 65-year-old man was diagnosed with granulomatosis with polyangiitis (GPA) based on the detection of high myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), vasculitis and granulomas in a lung biopsy specimen and crescentic glomerulonephritis in a kidney biopsy specimen. Soon after the initiation of intravenous methylprednisolone pulse therapy (mPSL pulse) and intravenous cyclophosphamide pulse therapy (IVCY), the patient experienced cough and hemoptysis. Based on emerging anemia and bilateral diffuse lung consolidation on computed tomography, we judged that diffuse alveolar hemorrhage (DAH) was complicated by GPA. The patient's DAH improved following additional mPSL pulse and IVCY. Physicians should be aware of the possible occurrence of DAH, even when a patient's symptoms improve after mPSL pulse and IVCY.

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