A rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage

• Published in: Clinical and experimental nephrology 2011-04, Vol.15 (2), p.303-307
• Main Authors: Nanba, Kazutaka, Yahata, Kensei, Kikuchi, Yuko, Okamoto, Chinatsu, Seta, Koichi, Sugawara, Akira
• Format: Article
• Language: English
• Subjects: Adult; Anti-Glomerular Basement Membrane Disease - diagnosis; Case Report; Diagnosis, Differential; Hemorrhage - etiology; Hemorrhage - pathology; Humans; Hypertension, Malignant - complications; Hypertension, Malignant - diagnosis; Hypertension, Malignant - pathology; Lung Diseases - etiology; Male; Medicine; Medicine & Public Health; Nephrology; Pulmonary Alveoli; Urology
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-010-0397-6

Malignant-phase hypertension is characterized clinically by severe accelerating hypertension with neuroretinopathy or papilledema and by evidence of renal damage. A Japanese male in his early thirties presented with hemoptysis and general fatigue. He had a 5-year history of hypertension, but had not received any treatment. His blood pressure was 290/150 mmHg and his serum creatinine level was 8.24 mg/dL. Chest X-rays and computed tomography scans of the chest revealed a pulmonary alveolar hemorrhage. He was suspected of having vasculitis syndrome or Goodpasture’s syndrome, but his renal biopsy specimen showed malignant nephrosclerosis. Myeloperoxidase antineutrophil cytoplasmic antibody (ANCA), proteinase-3 ANCA and antiglomerular basement membrane antibody were negative. He was treated with a calcium antagonist and a β-blocker, followed by an angiotensin-converting enzyme inhibitor. After the administration of the β-blocker, his blood pressure decreased and his renal function gradually improved. This is a rare case of malignant-phase hypertension with pulmonary alveolar hemorrhage; this condition should be considered in the differential diagnosis in order to avoid unnecessary treatment such as immunosuppressive therapy.