Diffuse alveolar infiltrates and macroscopic hematuria: a run-and-gun affair.

摘要

A 40-year-old taxi driver, current smoker and previously in good health, was admitted because of fever, cough with blood-tinged sputum and dyspnea of 5 days' duration. Two weeks prior to admission the patient developed a sore throat and tonsillar swelling. On admission, the patient was febrile (38.5°C), with dyspnea on exertion (category 3 of the modified Medical Research Council Dyspnea Scale) and the blood pressure was 140/95 mm Hg. Arterial blood gas analysis showed pH 7.39, Po2 7.8 kPa (59 mm Hg), PCO2 4.6 kPa (35 mm Hg), HCOi 22 mEq/1 and SaO2 90% on room air. Chest auscultation revealed inspiratory crackles at both mid and lower lung fields. The remainder of the physical examination was unremarkable, except slight lower limbs edema and 1-2 kg gain of body weight as referred by the patient. Laboratory data showed an elevated white blood cell count (13,570/|jl1) (segmented neutrophils 76%, lymphocytes 14%, eosinophils 1.7%) and a normochromic normocytic anemia (hemoglobin 10.4 g/dl). Lactate acid dehydroge-nase was elevated to 1,201 U/l.