Case 37

 A seventy six-year-old male came to our hospital for fever. Chest X ray and chest CT showed ground glass opacity in the right lung, suspicious of pneumonia (Figs 1-3). One year ago, he had experienced to admit in our hospital for three months due to pneumonia and vasculitis. During that time, he was given steroid pulse therapy and cyclophosphamide pulse therapy based on diagnosis of myeloperoxidase- antineutrophil cytoplasmic antibody (MPO-ANCA) associated pneumonia. One year ago, laboratory test revealed MPO-ANCA > 300 U/mL (< 3.5). Urine examination revealed red blood cell 50-94 (< 4) and positive proteinuria. Renal biopsy revealed no findings of angitis.
 Laboratory test at present revealed white blood cells of 1068/mm³, neutrophils 86.1 %, CRP 4.57 mg/dL, LDH 352 U/L, Creatinin 1.27 mg/dL, BUN 22.0 mg/dL and D dimer 7.1 μg/dL.　Then, he was given antibiotics this time but chest CT showed the worsening of pneumonia (Fig. 4).

What are the possible findings of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated pneumonia ?

a. Hemoptysis

b. Ground glass opacification

c. Honey comb pattern

d. Hematuria

e. Elevation of creatinin value

1. a, b, c　　 2. b, c, d 　　 3. c, d, e 　　 4. all　

answer

2016.12.21