PMC10032451_01
Peripheral subpleural consolidation, right greater than left (a) in the
setting of confluent centrilobular ground glass opacities with peripheral
sparing (b).
10.1177_26330040221130084-fig1.jpg
PMC10032451_01_10.1177_26330040221130084-fig1.jpg
fig1-26330040221130084
Computed tomography (CT) scan of the chest was performed and showed confluent centrilobular ground glass opacities which were thought to represent either atypical infection or mild alveolar hemorrhage (Figure 1(a) and (b)).
Biopsy findings: (a) histologic section stained with hematoxylin and eosin
reveals blood and red blood cell casts in the tubular lumens. Two glomeruli
demonstrate segmental fibrinoid necrosis surrounded by marked
hypercellularity suspicious for crescents. Some tubules appear dilated and
show features of acute tubular epithelial cell injury. No significant
chronic changes are seen (200x magnification). (b) Periodic acid Schiff
stain with one of the two glomeruli shown at higher magnification confirms a
small crescent with fibrin adjacent to an area of segmental mesangiolysis
(400x magnification). (c) Immunofluorescence stain for fibrin highlights a
glomerular segment with fibrinoid necrosis (400x magnification). (d)
Electron microscopy image shows a distended glomerular capillary lumen with
endocapillary hypercellularity adjacent to an area of mesangiolysis and
fibrin accumulation (bottom right). Diffuse podocyte foot process effacement
is seen (4800x magnification).
10.1177_26330040221130084-fig2.jpg
PMC10032451_01_10.1177_26330040221130084-fig2.jpg
fig2-26330040221130084
Pathology from the biopsy (Figure 2) demonstrated pauci-immune glomerulonephritis with early crescent formation, segmental fibrinoid necrosis, and mild acute tubular injury.