PMC3407666_01
HRCT scan at the level of middle lobe at presentation (a) shows geographic and nodular areas of ground-glass opacity bilaterally as well as branching centrilobular micronodules in the middle lobe consistent with alveolar hemorrhage. HRCT scan following two month corticosteroid treatment at the same level shows complete resolution of the above mentioned findings (b).
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fig1
Patient was then subjected to high-resolution computed tomography (HRCT) showing diffuse bibasilar ground-glass opacities consistent with alveolar hemorrhage (Figure 1).
Tissue sections ((a) and (b)) from the lung biopsy showed diffuse intra-alveolar red blood cell. There was, also, hemosiderin-laden macrophage accumulation (not shown). Interstitial fibrosis, granulomatous inflammation or capillaritis was not observed (Hematoxylin And Eosin stain, magnification x100:a and x200:b).
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fig3
Treatment with high doses of oral prednisone (0.75 mg/kg of weight) as a monotherapy was adopted for 6 weeks and gradually tapered to 0.5 mg/kr for another 6 weeks and 20 mgr for another 6 weeks leading to a profound improvement of symptoms (dyspnoea) as well as imaging and laboratory findings including complete resolution of bilateral areas of ground-glass opacities (Figure 3(b)) as well as a significant incline of his haemoglobin levels and decrease of his CRP and ESR titers, respectively.