Case 94

 An eighty three-year-old female was groaning voices in her own house. The neighborhoods heard her voices and called an ambulance. She was transported to our hospital. Her consciousness was unclear, she could be awakened by stimulation but instantly fell into sleep after stimulation: Japan coma scale II. Her eyes remained closed even if pain stimulation was given: Glasgow coma scale, eye opening I. Conjunctiva palpebral (eyelid) revealed marked anemia. Auscultation to her chest revealed coarse piping sound and marked bronchial stenosis sound. Bloody effusion was suck in a tube inserted to bronchial trees. Blood gas: Oxygen partial pressure was 66.5 mmHg under oxygen saturation of 92.6%. Laboratory test: red blood cells 221 x 104/mm³, Hemoglobin 6.8 mg/dL, white blood cells 10080/mm³, neutrophils 87.4 %, CRP 14.6 mg/dL, LDH 355 U/L, Creatinin 3.31mg/dL MPO-ANCA > 274 U/mL (< 3.5). Chest CT was taken for further investigation under her ambiguous consent (Fig.1).

Based on clinical symptoms, laboratory test and chest CT, what caused acute respiratory distress syndrome (ARDS) and pulmonary-renal syndrome ?

1. Systemic lupus erythematosus

2. Microscopic polyangiitis

3. Granuloma with polyangiitis

4. Eosinophilic granuloma with polyangiitis

5. Goodpasture syndrome (anti-glomerular membrane disease)

answer

2018.2.28