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S-476 A rare case of malignant hypertension with pulmonary alveolar hemorrhage needing dialysis
( Ch`ang Bum Rim ),( Jin Uk Jeong ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Introduction: Although blood pressure increases with age, it has been recognized that target organ injury is associated with rapid progressive blood pressure elevation in some individuals. If these blood pressure elevations are not treated, the mortality rate in patients with target organ injury, including papilledema and declining kidney function, can exceed 50% over 6-12 months; this hypertension is considered “malignant." Malignant hypertension is histologically characterized by fibrinoid necrosis of arterioles and rapid progression. It is observed in a variety of organs, including the kidneys, pancreas, gastrointestinal tract, liver, retina, brain, myocardium, prostate, and skeletal muscles. However, pulmonary hemorrhage is rare. Here, we report a rare case of malignant hypertension associated with pulmonary alveolar hemorrhage. Case: A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. The patient’s renal function was low, and he needed emergency renal replacement therapy. There was no evidence of Goodpasture syndrome; therefore, systemic lupus erythematosus or other forms of systemic vasculitis, malignant hypertension, and acute kidney injury were suspected. Antihypertensive therapy and hemodialysis were immediately started. A renal biopsy examination was performed to examine the underlying disease. Typical pathological changes associated with malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endarteritis at the interlobular arteries were observed. The patient’s renal function improved gradually and the pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Discussions: We reported a rare case of malignant hypertension with pulmonary alveolar hemorrhage and acute kidney injury that needed dialysis. It was difficult to determine whether the malignant hypertension was primary or secondary. Renal biopsy was used to exclude the possibility of underlying systemic diseases, such as systemic angiitis syndrome and Goodpasture’s disease.
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