[A case of diffuse alveolar hemorrhage accompanied by mesangial proliferative glomerulonephritis with positive perinuclear anti-neutrophil cytoplasmic antibody].

A 62-year-old man was admitted to our hospital because of low-grade fever and hemoptysis. Chest roentgenogram revealed diffuse infiltrative shadows with air bronchograms. Bronchoalveolar lavage fluid demonstrated bloody fluid, including many hemosiderin-laden macrophages. In addition, his laboratory data on admission revealed elevation of serum creatinine and BUN, and proteinuria and hematuria on urinalysis. Renal needle biopsy showed atrophic glomeruli and mesangial proliferative glomerulonephritis without crescent formation. A history of wheezing and slight eosinophila was also present, and we therefore suspected allergic granulomatous angitis. We performed airway sensitivity and reversibility tests, which were positive, and so we judged that he had an asthmatic component. Perinuclear antineutrophil cytoplasmic antibody (P-ANCA) was positive (x 1000) with ELISA. We diagnosed diffuse alveolar hemorrhage with mesangial proliferative glomerulonephritis and bronchial asthma. His general condition improved with oral administration of corticosteroid (50 mg/day) and immunosuppressive agent (cyclophosphamide; 50 mg/day), and his major symptoms disappeared within a few days.