Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan.
Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan.
Medicine (Baltimore). 2022 Sep 2;101(35):e30416. doi: 10.1097/MD.0000000000030416.
Alveolar hemorrhage presents with severe respiratory failure, requiring prompt diagnosis and treatment. Alveolar hemorrhage is often caused by autoimmune diseases accompanied by progressive renal dysfunction. However, few cases without autoimmune diseases occur, making diagnosis difficult. Here, we report a case of alveolar hemorrhage with hypertensive emergency.
A 28-year-old man presented with dyspnea and bloody sputum. His blood pressure was 200/120 mm Hg.
The chest computed tomography showed suggestive of alveolar hemorrhage. Renal dysfunction and proteinuria were observed. However, autoantibodies were not detected. Echocardiogram revealed left ventricular function decrease. Ejection fraction was 20% to 30% with no ventricular asynergy or any valvular diseases. Brain magnetic resonance imaging showed hyperintense lesions on fluid-attenuated inversion recovery in the white matter of both cerebral and right cerebellar hemispheres, which were compatible with posterior reversible encephalopathy syndrome. Renal biopsy did not reveal any immune-mediated glomerulonephritis or vasculitis, but hypertensive nephropathy was diagnosed.
Blood pressure was controlled with combination therapy using calcium channel blocker, angiotensin II receptor blocker, α1 blocker, and β blocker.
Alveolar hemorrhage and proteinuria improved with strict blood pressure control.
This case indicates that severe hypertension can possibly cause alveolar hemorrhage. Accumulating these cases is important for general physicians to diagnose the alveolar hemorrhage with hypertensive emergency in its early stage and to avoid unnecessary treatment such as immunosuppressive therapy.
肺泡出血表现为严重的呼吸衰竭，需要及时诊断和治疗。肺泡出血通常由自身免疫性疾病引起，并伴有进行性肾功能障碍。然而，也有少数无自身免疫性疾病的病例，导致诊断困难。本文报告了一例以高血压急症为表现的肺泡出血。
一名 28 岁男性因呼吸困难和咯血就诊。血压为 200/120mmHg。
胸部计算机断层扫描提示肺泡出血。肾功能障碍和蛋白尿。然而，自身抗体未被检测到。超声心动图显示左心室功能下降。射血分数为 20%至 30%，无室壁运动异常或任何瓣膜疾病。脑磁共振成像显示脑和右小脑半球白质的液体衰减反转恢复呈高信号病变，符合后部可逆性脑病综合征。肾活检未发现任何免疫介导的肾小球肾炎或血管炎，但诊断为高血压性肾病。
采用钙通道阻滞剂、血管紧张素 II 受体阻滞剂、α1 阻滞剂和β受体阻滞剂联合治疗控制血压。
肺泡出血和蛋白尿随着严格的血压控制而改善。
该病例表明严重高血压可能导致肺泡出血。积累这些病例对于普通医生早期诊断以高血压急症为表现的肺泡出血并避免不必要的治疗（如免疫抑制治疗）很重要。
