Nathaniel Reyes MD (NReyes@deptofmed.arizona.edu)
Jarrod Mosier MD (JMosier@aemrc.arizona.edu)
University of Arizona- AHSC/Pulmonary
1501 N Campbell Ave.
Tucson, AZ 85724-5030
History of Present Illness
A 50-year-old female who presented with 2-weeks of worsening cough and shortness of breath. She presented to another hospital 2-weeks prior to presentation complaining of cough productive of yellow sputum and was diagnosed with bronchitis and discharged home with a normal chest x-ray. Her symptoms persisted and one day prior to admission she experienced one episode of hemoptysis which prompted her presentation to our emergency department. She denied fever, chills, night sweats, and complained only of dyspnea on exertion.
PMH/SH
Granulomatous polyangitis (GPA) was diagnosed by renal biopsy in 2004. She subsequent developed end-stage renal disease and has been receiving peritoneal dialysis. She has never required immunosuppresive therapy. There is no history of tobacco use. She has lived in Arizona for many years. She is retired but previously worked as an information technology manager.
Physical Exam
Vital signs were normal except for an O2 saturation of 91% on room air. Physical exam was significant only for pale sclerae and bilateral dry crackles.
Laboratory Data
Hemoglobin: 5.4 g/dL; Hematocrit: 17%. BUN: 43 mg/dL; creatinine: 10.7 mg/dL.
ABG: PaO2 75; PaCO2 39; pH 7.43 on 2L O2.
P-ANCA: Positive
Myeloperoxidase antibody titer: 83 U/mL
C-ANCA/proteinase 3 antibody titer/Anti-GBM antibodies: negative.
Imaging
Chest X-ray showed diffuse areas of consolidation (Figure 1).
Figure 1. PA Chest X-ray
Which of the following is not appropriate in her management?
The authors report no conflict of interest.
Reference as: Reyes N, Mosier J. Critical care case of the month: different name, same disease...or is it? Southwest J Pulm Crit Care 2013;6(1):5-11. PDF