case_images: PMC11807395_01
case_images: Microscopic urine examination - crenulated red blood cells (blue arrows)
case_images: cureus-0017-00000077239-i01.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i01.jpg
case_images: FIG1
case_images: The urine culture was found to be sterile (Figure 1).
case_images: Chest X-ray: Unsystematized alveolar infiltrates ( white arrows) are present in the lower two-thirds of the lung fields, exhibiting a bilateral, peripheral, band-like distribution
case_images: cureus-0017-00000077239-i02.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i02.jpg
case_images: FIG2
case_images: A mixed pattern of diffuse lung infiltrates was observed, which includes nodular alveolar infiltrates and peri-broncho-vascular infiltrates (Figure 2).
case_images: Kidney ultrasound (right kidney)
case_images: cureus-0017-00000077239-i03.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i03.jpg
case_images: FIG3
case_images: Intraperitoneal fluid measuring 13 mm was noted (Figure 3).
case_images: Kidney biopsy. (A) Light microscopy revealed cellular crescents (black arrows) in all sampled 20 glomeruli with fibrinoid necrosis and Bowman's capsule destruction (red arrows). (B) Immunofluorescence presents linear glomerular capillary wall positivity, circumferential IgG deposits, and cellular crescents (red arrows).
case_images: cureus-0017-00000077239-i04.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i04.jpg
case_images: FIG4
case_images: The results, available three weeks later, confirmed pauci-immune glomerulonephritis characterized by fibrinoid necrosis and cellular crescents involving more than 90% of the glomeruli (Figure 4). Hemodialysis for kidney replacement therapy was commenced (Figure 4).
case_images: Chest X-ray: consolidation in the right lower and middle lobes (white arrows) indicative of lobar pneumonia
case_images: cureus-0017-00000077239-i05.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i05.jpg
case_images: FIG5
case_images: Following this dose, she developed pneumonia in the right lower and middle lobes, accompanied by hemoptysis (Figure 5).
case_images: Cerebral CT. (A) Ethmoidal sinusitis (blue arrows), (B) maxillar sinusitis (blue arrows), and (C) cerebral atrophy
case_images: cureus-0017-00000077239-i06.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i06.jpg
case_images: FIG6
case_images: Cerebral CT revealed cerebral atrophy and maxillo-ethmoidal sinusitis, with no indications of acute cerebral changes (Figure 6).
case_images: Cerebral MRI. Left thalamic signal abnormality (white arrow)
case_images: cureus-0017-00000077239-i07.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i07.jpg
case_images: FIG7
case_images: Cerebral MRI - hyperintensities (blue arrows) specific for PRES
case_images: cureus-0017-00000077239-i08.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i08.jpg
case_images: FIG8
case_images: Cerebral MRI - multiple thrombi in the cerebellar and cortical regions (blue arrows)
case_images: cureus-0017-00000077239-i09.jpg
case_images: PMC11807395_01_cureus-0017-00000077239-i09.jpg
case_images: FIG9