Case Report

Pulmonary Capillaritis in IgA Nephropathy

Authors: Devanand Anantham, MBBS, MRCP, Kenneth P.W. Chan, MBBS, FCCP, Khoon Leong Chuah, MBBS, FRCPA, Anantharaman Vathsala, MD, FRCP, Philip Eng, MBBS, FCCP

Abstract

Pulmonary capillaritis presenting as diffuse alveolar hemorrhage is a rare manifestation in patients with IgA nephropathy. A 20-year-old male with hemodialysis dependent, end-stage renal failure presented with recurrent hemoptysis and respiratory failure. A histologic diagnosis of pulmonary capillaritis was established by transbronchial lung biopsy. He was successfully treated with intravenous methylprednisone and plasma exchange followed by oral prednisone and cyclophosphamide. This report highlights the independent renal and pulmonary manifestations of IgA nephropathy and the management of the resultant diffuse alveolar hemorrhage with aggressive immunosuppression.


Key Points


* Pulmonary capillaritis is a rare manifestation of IgA nephropathy.


* Pulmonary capillaritis can occur independent of kidney disease in IgA nephropathy, long after the renal manifestations have apparently burnt out.


* Management requires prompt diagnosis and aggressive immunosuppression.

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