A 53-year-old male presented with a history of nasal crusting, intermittent episodes of “red eyes and skin rash”. Examination A 24-hour urine collection contained 800 mg of protein and his urinalysis revealed glomerular hematuria Investigations Serum creatinine - 2.0 mg/dl Anti-nuclear and antidsDNA antibody tests – Negative Proteinase-3 ANCA test - Positive Kidney biopsy – focal necrotizing glomerulonephritis with 10% crescents. 30% of glomeruli were globally sclerotic and there was focal mild-to-moderate interstitial fibrosis and tubular atrophy. The patient was treated with 3 doses of inj.
solumedrol (7 mg/kg/day x 3) along with inj. cyclophosphamide. Patient suddenly developed significant hemoptysis, hypoxemia and a chest X-ray consistent with diffuse alveolar hemorrhage. After that patient was treated with plasmapheresis in addition to corticosteroid and cyclophosphamide, and…
