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Jeong, Kang, Park, Kim, Kim, Kim, and Song: A Case of Pulmonary Fibrosis with Microscopic Polyangiitis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(3): 257-260.

Published online: 31 March 2011

DOI: https://doi.org/10.4046/trd.2011.70.3.257

A Case of Pulmonary Fibrosis with Microscopic Polyangiitis

Jae Ho Jeong, M.D.1, Sung Hee Kang, M.D.2, Se Jung Park, M.D.1, Dal Yong Kim, M.D.1, Woo Sung Kim, M.D.1, Dong Soon Kim, M.D.1, Jin Woo Song, M.D.1

1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Jin Woo Song, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3993, Fax: 82-2-3010-6968, skysong3@hanmail.net

Received 14 October 2010       Accepted 18 January 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

A 65-year-old woman was admitted due to poor oral intake and a dry cough over the previous 3 months. The physical examination was remarkable for bibasilar crackles, and plain chest radiography showed reticulation in both lower lung fields. A pulmonary function test demonstrated a restrictive pattern with a reduced diffusing capacity of the lung for carbon monoxide. High resolution computed tomography showed reticulation and honey-combing in both peripheral lung zones, which was consistent with usual interstitial pneumonia pattern. Her skin showed livedo reticularis. The erythrocyte sedimentation rate and C-reactive protein level were elevated, and hematuria was noted on urinary analysis. A serologic test for auto-antibodies showed seropositivity for Myeloperoxidase-Anti-neutrophil cytoplasmic antibody (MPO-ANCA). A kidney biopsy was performed and showed focal segmental glomerulosclerosis. She was diagnosed as having pulmonary fibrosis with microscopic polyangiitis (MPA) and treated with high dose steroids. Here we report a case of pulmonary fibrosis coexistent with microscopic polyangiitis.

Keywords: Pulmonary Fibrosis, Microscopic Polyangiitis, Antibodies, Antineutrophil Cytoplasmic

Figures and Tables

Figure 1
Chest PA shows coarse reticular opacities in both peripheral lung zone.
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Figure 2
High-resolution CT shows reticular opacity and honey-combing in both peripheral lung zone. CT: computer tomography.
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Figure 3
Medium sized vessel wall shows fibrinoid necrosis (H&E, ×200).
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Figure 4
Glomerulus shows focal fibrinoidnecrosis and interstitial inflammatory cell infiltration are observed (H&E, ×200).
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