Chest
Volume 96, Issue 4, October 1989, Pages 927-928
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Selected Reports
Pulmonary Capillaritis and Hemorrhage: A Clue to the Diagnosis of Systemic Necrotizing Vasculitis

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Patients with systemic necrotizing vasculitis frequently present as diagnostic dilemmas. In previous series of patients with polyarteritis nodosa, less than one third were diagnosed antemortem. Although current clinical awareness of systemic necrotizing vasculitis is greater than in the past and procedures for the diagnosis of these diseases have improved, patients commonly present with atypical features. The diagnosis of a systemic necrotizing vasculitis frequently remains unsuspected or unproven until an involved tissue is biopsied. We report an unusual case of systemic necrotizing vasculitis in which the diagnosis was confirmed by a transbronchial biopsy of the lung which demonstrated pulmonary capillaritis with hemorrhage.

Section snippets

CASE REPORT

A 72-year-old Portuguese woman was well until six months before her Stanford University Hospital admission when she noticed a unilateral hearing loss with malaise. Four months later, she was hospitalized at another facility with a fever, body ache, cough, right upper lobe infiltrate on chest x-ray film and hepatomegaly. The WBC was 21,000/cu mm; platelet count, 43,000; hemoglobin, 9 g/dl; and ESR, 95 mm/h. All blood, urine, and sputum cultures were negative. The patient's condition deteriorated

DISCUSSION

Pulmonary capillaritis and hemorrhage was first described in patients with hypersensitivity type reactions.1 Subsequently, it has been found to be associated with a variety of systemic vasculitides and collagen vascular diseases, particularly systemic lupus erythematosis.2, 3 It has been suggested that pulmonary capillaritis and hemorrhage in the appropriate setting might be useful in suggesting the diagnosis of a systemic necrotizing vasculitis.2, 4 Specific pathologic criteria have been noted

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Supported by training grant HL 07316 from the National Institutes of Health

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