Background Vasculitis presents several diagnostic challenges because patients could present with protean clinical manifestations and the range of differential diagnosis is broad. We report a pulmonary-renal syndrome in a 10-year-old boy referred to the Institute for Maternal and Child Healthcare.
Materials and methods A 10-year-old boy presented in April 2013 with rhinitis, fever and dry cough. His examination results were unremarkable except mild anaemia (9.9 g/dL) and markedly increased erythrocyte sedimentation rate (44 mm/h). A month later he had been admitted with complaints of proteinuria, hematuria and anaemia. In June he developed also arthritis. In October 2014 the child was admitted to the Paediatric Intensive Care Unit in a severe condition with rapidly progressive renal failure.
Results and discussion Antineutrophil cytoplasmic antibodies (ANCA) were positive with antigen specificity for myeloperoxidase (anti-MPO 37 KU/L). The other laboratory results included: mild anaemia and leukocytosis; proteinuria (69 mg/kg/day); increased blood urea nitrogen (BUN) and creatinine (10.4 mmol/L and 123 mmol/L, respectively). Thoracic CT revealed a solitary nodule 1.5 × 1 cm in the posterio-basal segment of the inferior lobe in the left lung. The next step would be to perform renal biopsy to confirm the diagnosis.
Conclusions Our aim in presenting this case is to alert clinicians that, even without the definitive histological diagnosis, it is necessary, based on clinical history and physical examination, and whenever possible serological tests (ANCA and anti-GBM), to start immunosuppressive therapy to interrupt fatal course of lung and kidney complications.