Abstract
An 84-year-old male complained of fever, cough, sputum, and appetite loss. His renal function rapidly worsened, and he had hypoalbuminemia and hypocomplementemia. His condition worsened and C-reactive protein levels were elevated. Vasculitis syndrome was suspected and he was administered 40 mg of prednisolone, although myeloperoxidase antineutrophil cytoplasmic antibody (ANCA), proteinase-3 ANCA and antiglomerular basement membrane antibody tests were negative. His body temperature decreased and fatigue promptly resumed. On renal biopsy, light microscopy revealed endocapillary and extracapillary glomerulonephritis. Vasculitis was detected in interlobular arteries. Immunofluorescence studies revealed granular deposits of C3 and IgG along capillary walls. Electron microscopy revealed dome-shaped small electron-dense granular subepithelial deposits. Acute post-infectious glomerulonephritis was suspected. Although his renal function improved, he developed hemoptysis and was diagnosed with pulmonary hemorrhage. He received methylprednisolone and plasma exchange, and his respiratory status improved gradually. This is an extremely rare case and suggests the importance of considering a differential diagnosis.
This is a preview of subscription content, log in via an institution to check access.
References
Moroni G, Pozzi C, Quaglini S, Segagni S, Banfi G, Baroli A, et al. Long-term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults. Nephrol Dial Transplant. 2002;17:1204–11.
Wong W, Morris MC, Zwi J. Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. 2009;24:1021–6.
Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol. 2011;22:187–95.
Bodaghi E, Kheradpir KM, Maddah M. Vasculitis in acute streptococcal glomerulonephritis. Int J Pediatr Nephrol. 1987;8:69–74.
Ingelfinger JR, McCluskey RT, Schneeberger EE, Grupe WE. Necrotizing arteritis in acute poststreptococcal glomerulonephritis: report of a recovered case. J Pediatr. 1977;91:228–32.
Zeledon JI, McKelvey RL, Servilla KS, Hofinger D, Konstantinov KN, Kellie S, et al. Glomerulonephritis causing acute renal failure during the course of bacterial infections. Histological varieties, potential pathogenetic pathways and treatment. Int Urol Nephrol. 2008;40:461–70.
Sung HY, Lim CH, Shin MJ, Kim BS, Kim YO, Song HC, et al. A case of post-streptococcal glomerulonephritis with diffuse alveolar hemorrhage. J Korean Med Sci. 2007;22:1074–8.
Gilboa N, McIntire S, Hopp L, Ellis D. Acute noncrescentic poststreptococcal glomerulonephritis presenting with pulmonary hemorrhage. Pediatr Nephrol. 1993;7:147–50.
Chugh KS, Gupta VK, Singhal PC, Sehgal S. Case report: poststreptococcal crescentic glomerulonephritis and pulmonary hemorrhage simulating Goodpasture’s syndrome. Ann Allergy. 1981;47:104–6.
Lam M, Krous HF, Llach F. Massive pulmonary hemorrhage and fulminant renal failure associated with immune complex glomerulonephritis. South Med J. 1981;74:1338–42.
Fukuda Y, Yamanaka N, Ishizaki M, Suzuki T, Masugi Y, Yajima G, et al. Immune complex-mediated glomerulonephritis and interstitial pneumonia simulating Goodpasture’s syndrome. Acta Pathol Jpn. 1982;32:361–70.
Masson RG, Rennke HG, Gottlieb MN. Pulmonary hemorrhage in a patient with fibrillary glomerulonephritis. N Engl J Med. 1992;326:36–9.
Nasr SH, Radhakrishnan J, D’Agati VD. Bacterial infection-related glomerulonephritis in adults. Kidney Int. 2013;83:792–803.
Conflict of interest
The authors have declared that no conflict of interest exists.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Koizumi, M., Yahata, K., Kaneko, K. et al. Post-infectious acute glomerulonephritis with vasculitis and pulmonary hemorrhage. CEN Case Rep 4, 65–69 (2015). https://doi.org/10.1007/s13730-014-0141-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13730-014-0141-2