Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 3-4, Pages: 233-238
https://doi.org/10.2298/SARH1404233M
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Diffuse alveolar hemorrhage in isolated pulmonary capillaritis: Case report
Medenica Milić (Special Hospital for Lung Diseases, Brezovik, Montenegro)
Medenica Miraš (Medicine at the University of St. Andrews, St. Andrews, UK)
Introduction. Pulmonary capillaritis is a small-diameter vessel vasculitis of
the lung, which may occur in isolation as in isolated pauci-immune
capillaritis, usually associated with the systemic vasculitis but it could be
also related to collagen vascular diseases and in lung transplant rejection.
Pulmonary capillaritis leads to diffuse alveolar hemorrhage. The clinical
presentation includes symptoms like dyspnea, cough, pleuritic chest pain,
fever and hemoptysis. Case Outline. A 48 year-old female patient, smoker,
presented with progressive dyspnea. Serum tests for infectious diseases,
collagen disorders and vasculitis were negative. Radiography and computed
tomography of the chest showed diffuse alveolar infiltrates. Cytology of
bronchoalveolar lavage showed presence of siderophages. A thoracoscopic lung
biopsy was performed to clarify the diagnosis. The histopathological findings
showed capillaritis and diffuse intraalveolar hemorrhage. Patient was treated
with steroids, and good clinical and minimal radiographic response was
obtained. Recently described pauci-immune pulmonary capillaritis has been
characterized as p-ANCA (antineutrophil cytoplasmic antibodies) negative
isolated pulmonary capillaritis. Conclusion. Isolated pauci-immune pulmonary
capillaritis is a rare disease. First clinical manifestations of the isolated
pulmonary capillaritis were the symptoms of progressive dyspnea, radiographic
and functional signs of the interstitial fibrosis. At the same time, the
signs of extrapulmonary diseases were not found. Presence of siderophages in
bronchoalveolar lavage indicated alveolar hemorrhage. Histopathological tests
of the sample of the lung pointed to pulmonary capillaritis and intraalveolar
hemorrhage. Prolonged treatment with corticosteroids was necessary.
Keywords: capillaritis, diffuse alveolar hemorrhage, dyspnea