case_images: PMC4531942_01
case_images: Positive C-ANCA in immunofluorescence testing(x100). Centrally accentuated finely granular cytoplasmic immunofluorescence is present in all neutrophils, with no stanining of neutrophil polymorphonuclear lobes.
case_images: kjim-13-1-68-13f1.jpg
case_images: PMC4531942_01_kjim-13-1-68-13f1.jpg
case_images: f1-kjim-13-1-68-13
case_images: Serology showed ANCA positive (C-ANCA pattern) in a titer of 1:640 (Fig. 1) and nasal septal biopsy showed the necrotizing granulomatous vasculitis.(Fig. 2,3).
case_images: Nasal septal biopsy shows granulomatous inflammtion with central neutrophilic infiltration and surrounding zone of histiocytes in cental area. The peripheral area shows dense lymphocytic infiltration(H & E stain, x100)
case_images: kjim-13-1-68-13f2.jpg
case_images: PMC4531942_01_kjim-13-1-68-13f2.jpg
case_images: f2-kjim-13-1-68-13
case_images: Serology showed ANCA positive (C-ANCA pattern) in a titer of 1:640 (Fig. 1) and nasal septal biopsy showed the necrotizing granulomatous vasculitis.(Fig. 2,3).
case_images: Chest radiogaph shows diffuse air-space consolidation with air-bronchogram in the whole right lung field.
case_images: kjim-13-1-68-13f4.jpg
case_images: PMC4531942_01_kjim-13-1-68-13f4.jpg
case_images: f4-kjim-13-1-68-13
case_images: Chest X-ray showed homogeneous, ill-defined, patch consolidation on right lung field(Fig. 4).
case_images: HRCT of the chest shows nonsegmental ground glass opacity with air-bronchogram in the right lung field.
case_images: kjim-13-1-68-13f5.jpg
case_images: PMC4531942_01_kjim-13-1-68-13f5.jpg
case_images: f5-kjim-13-1-68-13
case_images: Hemoglobin was 5.0g/dL, platelet 157,000/mm3 and HRCT showed diffuse pulmonary hemorrhage(Fig. 5) and bronchoscopic examination showed fresh oozing blood from distal airway.
case_images: Peripheral blood smear(Wright-Giemsa stain, x1000) shows frequent irregular shaped erythrocyte fragments.
case_images: kjim-13-1-68-13f6.jpg
case_images: PMC4531942_01_kjim-13-1-68-13f6.jpg
case_images: f6-kjim-13-1-68-13
case_images: The peripheral blood smear showed many RBC fragments(Fig. 6); lactate dehydrogenase was increased to 902 IU/L(normal, <500IU/L) with LD1 flipped pattern; haptoglobin was reduced to below 5.8mg/L(normal, 16 to 20Omg/L); Coombs' test and antiplatelet antibody were negative.