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71 yom w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), CKD3, BPH, LLE DVT (on apixaban), HTN, dyslipemia, hypothyroidism, and positive HBV surface antigen who presented with

  • acute kidney injury.
  • Hospital course complicated by
    • worsening kidney failure, hypoxemic
    • respiratory failure from
      • DAH,
      • MSSA PNA.
    • uremic encephalopathy,
    • hyperkalemia,
    • E faecalis UTI, and MSSA pneumonia/bacteremia.
    • Intubated for severe hypoxemic respiratory failure refractory to maximal HFNC support.
    • Bronchoscopic findings were
      • consistent with DAH.
  • CXR 1 month ago
  • 71M CXR 1 month ago Normal CXR
    Dx lungs kidneys pulmonary hemorrhage anca vasculitis
    Ashley Davidoff TheCommonVein.net

    1 Month Later Diffuse Alveolar Hemorrhage and MSSA Pneumonia 

    Multicentric Pulmonary Hemorrhage and Pneumonia
    71 yo m w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), presents with acute respiratory failure. Bronchoscopic findings were consistent with diffuse alveolar hemorrhage associated with MSSA (Methicillin Sensitive Staph Aureus ) pneumonia/bacteremia
    CXR shows multicentric consolidations likely a combination of alveolar hemorrhage and pneumonia
    Ashley Davidoff TheCommonVein.net

    Multicentric Pulmonary Hemorrhage and Pneumonia
    71 yo m w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), presents with acute respiratory failure. Bronchoscopic findings were consistent with diffuse alveolar hemorrhage associated with MSSA (Methicillin Sensitive Staph Aureus ) pneumonia/bacteremia.  Note Consolidation surrounded by ground glass opacity, the latter likely reflecting a hemorrhagic component
    CTscan shows multicentric consolidations likely a combination of alveolar hemorrhage and pneumonia
    Ashley Davidoff TheCommonVein.net
    Multicentric Pulmonary Hemorrhage and Pneumonia
    71 yo m w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), presents with acute respiratory failure. Bronchoscopic findings were consistent with diffuse alveolar hemorrhage associated with MSSA (Methicillin Sensitive Staph Aureus ) pneumonia/bacteremia.  Note Consolidation surrounded by ground glass opacity, the latter likely reflecting a hemorrhagic component
    CTscan shows multicentric consolidations likely a combination of alveolar hemorrhage and pneumonia
    Ashley Davidoff TheCommonVein.net
    Multicentric Pulmonary Hemorrhage and Pneumonia
    71 yo m w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), presents with acute respiratory failure. Bronchoscopic findings were consistent with diffuse alveolar hemorrhage associated with MSSA (Methicillin Sensitive Staph Aureus ) pneumonia/bacteremia.  Note Consolidation surrounded by ground glass opacity, the latter likely reflecting a hemorrhagic component
    CTscan shows multicentric consolidations likely a combination of alveolar hemorrhage and pneumonia
    Ashley Davidoff TheCommonVein.net

     

CXR 1 week Later Shows Significantly Improved Multicentric Pulmonary Hemorrhage and Pneumonia

CXR 1 week Later Significantly Improved Multicentric Pulmonary Hemorrhage and Pneumonia
71 yo m w/ a hx of recently diagnosed ANCA-associated vasculitis (diagnosed by kidney biopsy), presents with acute respiratory failure. Bronchoscopic findings were consistent with diffuse alveolar hemorrhage associated with MSSA (Methicillin Sensitive Staph Aureus ) pneumonia/bacteremia
CXR 1 week after CT scan shows significant improvement of multicentric consolidations likely a combination of alveolar hemorrhage and pneumonia. It is well known that pulmonary hemorrhage resolves fairly quickly
Ashley Davidoff TheCommonVein.net

 

reference ID 6195