PMC6507154_01
(a) Light microscopy reveals glomeruli with cellular to focally fibrocellular crescent formation and underlying segmental tuft fibrinoid necrosis. Red blood cell casts are noted. There is severe mononuclear inflammation within the interstitium (H&E, 10x). (b) Electron microscopy demonstrates peripheral capillary loops of normal thickness and architecture with widespread effacement of the overlying foot processes. (c) Immunofluorescence microscopy shows strong linear staining along glomerular basement membranes with IgG (4+) and kappa and lambda light chains (3-4+).
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Light microscopy showed necrotizing and crescentic glomerulonephritis with fibrocellular crescent formation (Figure 1(a)). Electron microscopy demonstrated widespread podocyte foot process effacement and linear deposits along the glomerular basement membrane (Figure 1(b)) confirmed as IgG by immunofluorescence (Figure 1(c)).
Portable chest radiograph demonstrates diffuse bilateral patchy opacities.
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A portable chest radiograph showed diffuse bilateral patchy opacities (Figure 2).
CTA of the chest with IV contrast reveals extensive bilateral consolidations.
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A computerized tomography angiography (CTA) of the chest with IV contrast confirmed diffuse bilateral consolidations (Figure 3).
Progressive increase in intensity of blood in sequential aliquots during BAL strongly suggests active alveolar hemorrhage.
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Flexible fiberoptic bronchoscopy was performed, and the bronchoalveolar lavage (BAL) fluid was consistent with alveolar hemorrhage (Figure 4).