Abstract
A 65-year-old woman was admitted to our hospital with complaints of hemosputum and dyspnea. The clinical diagnoses were marked anemia, pulmonary hemorrhage, and renal disturbance. Infusion of methylpredonisolone was not effective and pulmonary hemorrhage induced rapidly progressive pulmonary failure. Abnormal lung shadows on chest X-P, her symptoms and hypoxemia were improved within 24 hours after plasma exchange was performed on the 3rd hospital day. The patient died on the 8th hospital day of sepsis and DIC. Postmortem histological findings revealed partially crescentic formation and widely hyalinized and collapsed change within the glomeruli, proximal and distal tubular degeneration, and massive intra-and extra-alveolar hemorrhages. Immunofluorescence studies revealed granular accumulations of IgG and C3 within the glomeruli, but no significant finding within the lung. Her serum antiglomerular basement membrane antibody was negative.
We conclude that the final diagnosis was pulmonary hemorrhage of unknown cause complicated with renal failure probably due to acute exacerbation of chronic glomerulonephritis, and that the relationship between pulmonary hemorrhage and glomerulonephritis was obscure.
