oa Current Allergy & Clinical Immunology - Clinical image

Volume 23, Issue 3
  • ISSN : 1609-3607



An 11-year-old girl presented to our services with the complaint of shortness of breath and a cough productive of blood-streaked sputum. Clinically she had signs of respiratory distress and a few scattered fine crackles. Chest radiograph showed diffuse alveolar infiltrates throughout the lung fields. Flow-volume loops demonstrated small volume lungs with a restrictive pattern. A computed tomography (CT) scan of the chest revealed bilateral acinar nodules with areas of confluence and background groundglass appearance. Bronchoscopy was normal and broncho-alveolar lavage showed haemosiderin-laden macrophages, confirming the diagnosis of pulmonary haemorrhage. She was also noted to have had an earlier diagnosis of crescentic glomerulonephritis confirmed by renal biopsy. She was antinuclear antibody (ANA) and antidouble-stranded DNA (anti-dsDNA) negative, but perinuclear antineutrophil cytoplasmic antibody (p-ANCA) was strongly positive. Complement levels were normal.

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