RT Book, Section A1 Makol, Ashima A1 Warrington, Kenneth J. A2 Dean, Steven M. A2 Satiani, Bhagwan A2 Abraham, William T. SR Print(0) ID 1105292393 T1 MICROSCOPIC POLYANGIITIS T2 Color Atlas and Synopsis of Vascular Diseases YR 2015 FD 2015 PB McGraw-Hill Medical PP New York, NY SN 9780071749541 LK accesssurgery.mhmedical.com/content.aspx?aid=1105292393 RD 2024/03/28 AB A 68-year-old woman was hospitalized for evaluation of progressive dyspnea, cough, and hemoptysis. She had a 2-month history of malaise, anorexia, arthralgias, and a 30-lb weight loss. Symptoms did not improve with outpatient antibiotic therapy. Laboratory studies were significant for profound anemia, elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and decreased renal function. Perinuclear-pattern antineutrophil cytoplasmic antibody (p-ANCA) and myeloperoxidase (MPO) antibody were positive. Urinalysis showed microscopic hematuria with granular and red blood cell casts. Chest radiograph revealed bilateral alveolar infiltrates (Figure 79-1). Bronchoscopy with bronchoalveolar lavage was consistent with alveolar hemorrhage, and transbronchial lung biopsy showed changes of pulmonary capillaritis (Figure 79-2). An extensive infectious workup was negative. A diagnosis of microscopic polyangiitis (MPA) was made. The patient was treated with high-dose corticosteroids and oral cyclophosphamide, resulting in gradual clinical improvement. She was subsequently switched to azathioprine for maintenance of remission.