CHEST Guidelines-An-80-Year-Old-Man-With-Hemoptysis-and-Unilateral-

An-80-Year-Old-Man-With-Hemoptysis-and-Unilateral-

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An 80-year-old man presented with a 5-day history of hemoptysis, mild shortness of breath, fatigue, and malaise. He had a history of hypertension, congestive heart failure, past renal cancer surgery, and substantial past smoking. Physical examination showed crackles on the right chest and symmetrical arthritis, but without fever or other acute distress. Blood tests revealed anemia, elevated inflammatory markers, and impaired renal function. Chest imaging detected diffuse opacities in the right lung.<br /><br />A bronchoscopy and bronchoalveolar lavage (BAL) showed red blood cells and hemosiderin-laden macrophages, but cultures were negative for infections. Immunological tests identified perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs), suggesting microscopic polyangiitis (MPA) with diffuse alveolar hemorrhage (DAH).<br /><br />MPA is an inflammatory disease causing small to medium vessel vasculitis, often involving DAH and renal impairment. DAH symptoms may include hemoptysis, anemia, and respiratory issues. Distinguishing MPA from similar conditions, like granulomatosis with polyangiitis (GPA), involves identifying the absence of granulomas and upper respiratory involvement in MPA. Prompt treatment with high-dose corticosteroids and cyclophosphamide or rituximab is critical.<br /><br />The patient's clinical course included treatment with IV methylprednisolone and cyclophosphamide, resulting in improved lung opacities and normalization of renal function and blood test parameters. He remained in remission for 12 months post-treatment.<br /><br />This case underscores the importance of early diagnosis and treatment in MPA with DAH due to its potential severity and complications. Proper differentiation of MPA from other similar diseases and initiating appropriate therapy are crucial for favorable outcomes.

Keywords

microscopic polyangiitis

diffuse alveolar hemorrhage

hemoptysis

p-ANCAs

vasculitis

corticosteroids

cyclophosphamide

renal impairment

bronchoscopy

high-dose treatment