case_images: PMC11802193_01
case_images: CT chest without contrast during the first hospitalization
case_images: cureus-0017-00000077100-i01.jpg
case_images: PMC11802193_01_cureus-0017-00000077100-i01.jpg
case_images: FIG1
case_images: Renal ultrasound demonstrated echogenic kidneys suggestive of medical renal disease without evidence of obstructive uropathy, and CT chest without contrast (Figure 1) revealed mild infiltrate on the left lung base, subsegmental atelectasis, and trace right pleural effusion.
case_images: Serum creatinine during the first hospitalization
case_images: cureus-0017-00000077100-i02.jpg
case_images: PMC11802193_01_cureus-0017-00000077100-i02.jpg
case_images: FIG2
case_images: After beginning the treatment regimen, the patient's creatinine began to show improvement, downtrending on day 7 (Figure 2).
case_images: Renal biopsy with light, immunofluorescence, and electron microscopy specimens. A. fibrinoid necrosis; B. cellular crescent; C. fibrocellular crescent; D. necrotizing arteritis; E. glomerular C3; F. mesangial deposits; G. subepithelial deposits; H. acute tubulointerstitial nephritis (ATN)
case_images: cureus-0017-00000077100-i03.jpg
case_images: PMC11802193_01_cureus-0017-00000077100-i03.jpg
case_images: FIG3
case_images: Renal biopsy resulted in findings consistent with diffuse active necrotizing and crescentic glomerulonephritis, as well as the following findings: segmentally thickened glomerular capillary basement membranes, acute tubulointerstitial nephritis, acute tubular necrosis, and mild arteriosclerosis (Figure 3).
case_images: Serum white blood cell count during the first hospitalization. WBC: white blood cell count
case_images: cureus-0017-00000077100-i04.jpg
case_images: PMC11802193_01_cureus-0017-00000077100-i04.jpg
case_images: FIG4
case_images: The patient remained afebrile throughout the rest of the hospital course after initial presentation to the ED, although leukocytosis with neutrophilic predominance persisted throughout the hospital stay (Figure 4).
case_images: Serum creatinine during the second hospitalization
case_images: cureus-0017-00000077100-i05.jpg
case_images: PMC11802193_01_cureus-0017-00000077100-i05.jpg
case_images: FIG5
case_images: His creatinine downtrended with consistent hemodialysis (Figure 5), and creatinine on discharge was 4.98.