Page 11 / March 07
Severe diffuse pulmonary hemorrhage with mild capillaritis.
The differential diagnosis includes idiopathic pulmonary hemorrhage (IPH) and there is no evidence of Wegener's granulomatosis, microscopic polyangiitis or other necrotizing vasculitis in this biopsy.
Due to the exacerbation of his bleeding and deterioration in his respiratory condition be was re-pulsed with methylprednisolone at 30 g/kg/day whilst awaiting the pathological analysis. He was also treated with intravenous immunoglobulin to maintain levels greater than 40 g/L. He continues to bleed and requires further transfusion.
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ANSWER:
Severe diffuse pulmonary hemorrhage with mild capillaritis.
The differential diagnosis includes idiopathic pulmonary hemorrhage (IPH) and there is no evidence of Wegener's granulomatosis, microscopic polyangiitis or other necrotizing vasculitis in this biopsy.
Due to the exacerbation of his bleeding and deterioration in his respiratory condition be was re-pulsed with methylprednisolone at 30 g/kg/day whilst awaiting the pathological analysis. He was also treated with intravenous immunoglobulin to maintain levels greater than 40 g/L. He continues to bleed and requires further transfusion.
Keeping in mind the findings from the lung biopsy and with clear evidence of bleeding despite re-pulsing what is your next approach?
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