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- W2045093810 abstract "A 51-year-old woman had 1 week of cough and dyspnea. Her primary care provider had prescribed azithromycin and albuterol without improvement but had not obtained a chest radiograph. She presented to the emergency department with worsened dyspnea, fever, and hemoptysis. Her chest radiograph showed diffuse alveolar infiltrates (Figure 1), and she was found to have acute renal failure. She was intubated because of progressive hypoxemic respiratory failure and bronchoscopy-confirmed diffuse alveolar hemorrhage. Pulmonary-renal syndrome caused by microscopic polyangiitis. Serologic testing result was positive for Perimuclear-antineutrophil (P-ANCA) cytoplasmic antibody, and renal biopsy showed crescentic membranoproliferative glomerulonephritis and confirmed the diagnosis of microscopic polyangiitis (Figure 2). She was treated with high-dose intravenous steroids and cyclophosphamide, with improvement of both her pulmonary and renal function; she was weaned from the ventilator and did not require further hemodialysis. After a 34-day hospitalization, she was discharged home receiving oral prednisone and cyclophosphamide. Microscopic polyangiitis is one of the antineutrophil cytoplasmic antibody–associated vasculitides, along with Wegener's granulomatosis and Churg-Strauss syndrome. It is due to antibodies directed against proteinase 3 or myeloperoxidase and causes a small-vessel necrotizing vasculitis.1Kallenberg C.G. Pathophysiology of ANCA-associated small vessel vasculitis.Curr Rheumatol Rep. 2010; 12: 399-405Crossref PubMed Scopus (74) Google Scholar, 2Kallenbaerg C.G. Stegeman C.A. Abdulahad W.H. et al.Pathogenesis of ANCA-associated vasculitis.Am J Kidney Dis. 2013; 62: 1176-1187Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Classically with renal and pulmonary involvement, microscopic polyangiitis is characterized by crescentic glomerulonephritis and alveolar hemorrhage. Treatment is based on systemic corticosteroids and immunosuppressants, particularly cyclophosphamide.3Ribi C. Pagnoux C. Mahr A. et al.Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors.Arthritis Rheum. 2010; 62: 1186-1197Crossref PubMed Scopus (147) Google Scholar, 4Gayraud M. Guilevin L. Toumelin P. et al.Long-term follow-up of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome.Arthritis Rheum. 2001; 44: 666-675Crossref PubMed Scopus (484) Google Scholar" @default.
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- W2045093810 date "2015-01-01" @default.
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- W2045093810 title "Woman With Cough and Dyspnea" @default.
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- W2045093810 doi "https://doi.org/10.1016/j.annemergmed.2014.04.020" @default.
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