Chest CT and laboratory test characteristics of microscopic polyangitis with pulmonary infection / 中华放射学杂志

Objective To investigate the imaging features of chest CT and characteristics of laboratory tests in microscopic polyangitis (MPA) with pulmonary infection. Methods Based on the results of sputum culture, 42 patients with MPA were divided into two groups, MPA with pulmonary infection (16 cases)and MPA without pulmonary infection (26 cases). The results of chest CT images and laboratory tests were compared between the 2 groups by χ2 test (or Fisher exact test) and student t test (or Mann-Whitney U test), respectively. Results Compared with patients without pulmonary infection, patients with pulmonary infection showed patchy opacities(15/16 cases versus 14/26 cases,χ2=5.631,P=0.018)and consolidations(7/16 cases versus 2/26 cases,χ2=5.657,P=0.017)more frequently. Patchy opacities showed peripheral distribution less frequently in the MPA with pulmonary infection group than in the MPA without pulmonary infection group (6/15cases versus 12/14 cases,P=0.021). Patients with pulmonary infection showed the same frequent as the patients without pulmonary infection in the following CT findings including ground glass opacities, pleural effusions, mediastinal adenopathy and pulmonary fibrosis (P>0.05). The MPA with pulmonary infection group had higher neutrophil ratio than the MPA without pulmonary infection group (0.84 ± 0.12 versus 0.74 ± 0.11,t= 2.845,P= 0.007). Conclusions The MPA patients with pulmonary infection show patchy opacities and consolidations more frequently, and have higher neutrophil ratio than the MPA without pulmonary infection. The characteristics can be helpful in the diagnosis of pulmonary infection in the MPA patients and guild the treatment.

Vasculites pulmonares: achados morfológicos e diagnóstico diferencial / culites lung: morphological findings and differential diagnosis

As vasculites são um conjunto de entidades clínico-patológicas sistêmicas caracterizadas pela destruição da parede de vasos sanguíneos. O parênquima pulmonar é consistentemente mais afetado por três vasculites em particular: granulomatose de Wegener (ou granulomatose com poliangite), síndrome de Churg-Strauss e poliangite microscópica. Demograficamente, estas doenças inflamatórias afetam adultos de meia idade, e apresentam-se com sinais e sintomas respiratórios, além de sintomas sistêmicos. O diagnósico destas entidades recais na correlação da apresentação clínica e correlação desta com achados radiológicos e morfológicos. O diagnóstico diferencial das três vasculites pulmonares mais comuns é principalmente com infecções granulomatosas, como micobacterioses e infecções fúngicas, linfomas e outras vasculites. Este artigo explora as principais características histopatológicas e o diagnóstico diferencial destas entidades

Vasculitides are a group of systemic diseases characterized by the destruction of the blood vessels walls. The pulmonary parenchyma is consistently affected by three vasculidites in particular, namely, Wegener granulomatosis (or granulomatosis with polyangeitis), Churg-Strauss syndrome and microscopic polyangitis. Demographically toms. The diagnosis of this group of diseases is based on the correlation of the clinical picture with radiologic and morphologic findings. Differential diagnosis is mostly done with granulomatous infectious, such as mycobacteria and fungus, lymphomas and other vasculidites. This article explores the main histopathologic characteristics of these vasculidites as well as their main differential diagnoses

Decade Long Unexplained Anemia: Alert to ANCA Associated Vasculitis.

A 13-year old girl presented with a decade long anemia, diffuse alveolar hemorrhage and interstistial lung disease; was eventually diagnosed as ANCA associated vasculitis. High index of suspicion is thus warranted for alternative diagnosis in chronic anemia, despite increased prevalence of infectious diseases and nutritional anemia.

Clinical outcomes of renal patients treated with therapeutic plasma exchange / 대한내과학회지

BACKGROUND: Therapeutic plasma exchange (TPE) is a procedure by which plasma is removed from whole blood and this can be used in the treatment of some renal diseases. METHODS: We reviewed the medical records for the chief complaints, underlying diseases, clinical courses and treatment outcomes of 23 patients who had been treated with TPE at the Renal Division of Chungnam National University Hospital from January 1995 to June 2005. RESULTS: Patients with thrombotic thrombocytopenic purpura (TTP), microcopic polyangitis, lupus nephritis, hyperacute humoral rejection after kidney trasnplantation and rapidly progressive glomerulonephritis (RPGN) secondary to subacute bacterial endocarditis were included in this study. Among the 11 patients with TTP, six patients improved and two patients progressed to end-stage renal disease (ESRD). Three patients with TTP died. Seven patients with microscopic polyangitis and two patients with lupus nephritis had pulmonary hemorrhage at the time of TPE. Eight of the 11 TTP patients showed improvement of their pulmonary hemorrhage after TPE. One of the two patients with hyperacute humoral rejection after kidney transplantation and one patient with secondary RPGN were improved after TPE. Hypotension (three cases) was the most common adverse effect of TPE, followed by two cases of itching sensation and one case of fever with chills. CONCLUSIONS: Therapeutic plasma exchange was an effective treatment for patients with TTP, microscopic polyangitis, lupus nephritis with pulmonary hemorrhage and hyperacute humoral rejection after kidney transplantation.

A Case of Microscopic Polyangitis Presented as Pulmonary Hemorrhage and Rapidly Progressive Glomerulonephritis

Microscopic polyangitis(MPA) is defined as a systemic necrotizing vasculitis that affects small-sized vessels without granulomata. MPA is associated with focal segmental necrotizing glomerulonephritis. Clinical manifestations are similar to those of polyarteritis nodosa, but are characterized by the presence of rapidly progressive glomerulonephritis and pulmonary involvement, including pulmonary hemorrhage. We reported a case of microscopic polyangitis presenting pulmonary hemorrhage and rapidly progressive glomerulonephritis with a brief review of literatures.