This case was contributed by Doctors Lauren Monda and Robert Wright, Santa Barbara Cottage Hospital, CA
Clinical summary: A 17-year-old youth was transferred from his local hospital for treatment of persistent pneumonia on 5/19. Six weeks before admission, he developed malaise and had a transient urticarial skin rash involving the face and extremities. Four weeks before admission, he developed fever to 102 degrees, night sweats, and anorexia. He had a mild cough without sputum. A chest radiograph showed a lobar pneumonia. He was hospitalized and treated with multiple antibiotics to no avail. Dyspnea developed, and he was transferred to a regional medical center. On admission, his oxygen saturation on air was 96%, and hemoglobin was 9.8 g/dl with an MCV of 77 µ3. Hematuria, proteinuria, and a serum creatinine of 1.8 mg/dl were noted. At bronchoscopy the airways were slightly hyperemic. A transbronchial biopsy showed organizing pneumonia. The hemoglobin dropped to 7.3 g/dl over the next two days, and he received a blood transfusion. Soon thereafter, hemoptysis occurred. A chest CT on 5/25 showed an increase in opacities. At the same time, the patient required 6 L of oxygen by face mask to maintain an oxygen saturation of 92-94%. The creatinine had risen to 2.8 mg/dl. Urinary protein was 30 to 100 mg/dl, and there were numerous RBCs and occasional granular casts. A 24-hour urinary protein was 1.8 g. On 5/27, a renal biopsy and a thoracoscopic lung biopsy were performed.
Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Image 5 | Discussion
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