PMC4867975_01
Simple chest radiographs. a 6 months before admission, numerous nodules in both lungs were observed. The majority of the nodules were quite dense suggesting calcification. b Upon admission, newly developed haziness was noted in both lungs suggesting pneumonia, edema, or hemorrhage
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Fig1
An initial chest radiograph revealed newly developed haziness in both lungs suggesting pneumonia, pulmonary edema, or hemorrhage (Fig. 1b).
Low-dose chest computed tomography (LDCT). a 2 years before admission, numerous calcified nodular infiltrations were present in whole lung fields. Minimal subpleural septal thickening with reticulations in the right middle lobe (RML) and both lower lobes (BLLs) were observed. Lymph node enlargements with calcifications were found in the mediastinum, hilum, interlobar, and lobar regions. b Upon admission, multifocal patchy areas of consolidation were found in both lungs suggesting extensive pneumonia. Furthermore, diffuse ground glass opacity was noted in both lungs suggesting pulmonary edema with or without hemorrhage
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Fig2
Low-dose chest CT revealed a newly developed multifocal patchy consolidation in both lungs indicating extensive pneumonia, and a diffuse ground glass opacity suggesting pulmonary edema with or without hemorrhage in both lungs (Fig. 2b).
Light microscopic examination using PAS staining. Light microscopic examination was performed using special staining with M-trichrome, silver, PAS, and Verhoeff-Van Gieson elastic. Fibrocellular crescents in some glomeruli and chronic interstitial fibrosis in tubulointerstitium were observed. The kidney biopsy was found to be consistent with chronic sclerosing glomerulonephritis with acute tubular necrosis, possibly due to ANCA-associated crescentic glomerulonephritis and arteriosclerosis. The electron microscopic examination revealed totally sclerosed glomeruli which was no specific deposition for ANCA-associated crescentic glomerulonephritis
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Fig3
Light microscopy revealed a chronic sclerosing glomerulonephritis suggesting ANCA-associated crescentic glomerulonephritis (Fig. 3).
Immunoflourescence microscopic finding. Immunofluorescence revealed scant amounts of granular C3 deposits. In this examinations, no specific deposition for ANCA-associated crescentic glomerulonephritis was found
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Fig4
P-ANCA was detected using indirect immunofluorescence microscopy in serum (at a titer of 1:80), and in biopsied kidney (Fig. 4).
Simple chest radiograph after the remission. About 11 months after the remission, there was cleared pneumonic infiltration in both lower lung fields since prior study. Little interval change of underlying pneumoconiosis was seen
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Fig5
By 11 months, he maintained remission without immunosuppressant (Fig. 5).