Pathological and Radiological Correlation in Prolonged Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-related Diffuse Alveolar Hemosiderosis

• Published in: Internal Medicine Vol. 59; no. 3; pp. 415 - 419
• Main Authors: Saraya, Takeshi, Fujiwara, Masachika, Yokoyama, Takuma, Takata, Saori, Oka, Teruaki, Ishii, Haruyuki, Takizawa, Hajime
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.02.2020; Japan Science and Technology Agency
• Subjects: Alveoli; Antineutrophil cytoplasmic antibodies; Case Report; Computed tomography; Cough; Fever; hemosiderin laden alveolar macrophage; Hemosiderosis; Internal medicine; Macrophages; MPO-ANCA; Neutrophils; Nodules; Peroxidase; Septum; Surgery; thoracic computed tomography; Thoracic surgery; Thorax; Vasculitis; MPO-ANCA; thoracic computed tomography; hemosiderin laden alveolar macrophage; hemosiderosis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3107-19

A 60-year-old woman with a 20-year history of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis visited our hospital due to productive cough and a low-grade fever for several weeks. Thoracic computed tomography demonstrated scattered tiny nodules, patchy consolidation, ground glass opacities, and thickening interlobular septa. On video-assisted thoracic surgery, those abnormalities were found to correspond to the accumulation of hemosiderin-laden alveolar macrophages (AMs) in the alveolar spaces and alveolar septa due to MPO-ANCA vasculitis. The radiological findings persisted for a further two years, indicating the possibility of persistent vasculitis in the lung or evidence of incomplete clearance of hemosiderin-laden AMs.