PMC7386058_01
A: Chest radiograph showing extensive bilateral alveolar shadowing and cardiomegaly; cardiothoracic ratio 60%. B: High-resolution chest computed tomography on the first day revealed diffuse perihilar ground-glass attenuation with some areas of consolidation along the bronchial vascular bundle.
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Figure1
There were no pleural effusions (Figure 1A). High-resolution chest computed tomography (CT) showed diffuse perihilar ground-glass attenuation with some areas of consolidation along the bronchial vascular bundle (Figure 1B).
In bronchoalveolar lavage, a large number of hemosiderin-laden macrophages are histologically confirmed, which indicate an alveolar hemorrhage (Berlin blue stain).
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Figure2
Using a bronchoalveolar lavage fluid test, macroscopic alveolar hemorrhage was observed and a large number of hemosiderin-laden macrophages were histologically confirmed (Figure 2).
Clinical course in this case. PE = plasma exchange; mPSL = methylprednisolone; SBP = systolic blood pressure; DBP = diastolic blood pressure; NPPV = noninvasive positive pressure ventilation; Cr = creatinine; Plt = platelet count.
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Figure3
TMA was made based on previous reports. The clinical course is shown in Figure 3.
Alveolar bleeding gradually disappeared in the chest computed tomography on day 35.
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Figure4
Alveolar hemorrhaging gradually improved, and the diffuse ground-glass shadows disappeared on chest CT images on day 35 (Figure 4).
Light microscopic findings of kidney biopsy. A: In glomeruli, cell proliferative changes are scarce, and no findings suggestive of vasculitis, such as crescent formation, are observed (periodic acid-Schiff staining, original magnification x 400). B: The presented glomeruli show ischemic changes. The capillary walls are thickened and wrinkled. Tubular atrophy, dropout, and interstitial fibrosis are observed in a wide area (periodic acid-methenamine silver (PAMS) staining, original magnification x 200). C: Vascular lesions caused by persistent hypertension are characterized. In the arterioles, intimal thickening with proliferation of smooth muscle cells are observed (PAMS staining, original magnification x 400). D: Interlobular artery presents "onion skin" thickening with a narrowing lumen (Elastica masson staining, original magnification x 400).
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Figure5
Renal pathological images are presented in Figure 5.