Hemoptysis Revealing Microscopic Polyangiitis: A Case Report - Abstract
Microscopic polyangiitis is a rare systemic necrotizing vasculitis of unknown origin that affects small-caliber vessels. We report the case of a 42 years old némale patient who presented for 4 months several episodes of gradual onset, medium-abundance haemoptysis, associated with worsening dyspnoea to mMRC stage II and burning-type mid-thoracic pain, in a context of apyrexia and weight loss without quantification. The clinical examination was essentially normal, apart from some mucocutaneous pallor. Chest radiography revealed diffuse bilateral reticulo-micronodular infiltrates. Chest CT scan showed bilateral groundglass opacities associated with reticulations giving a “crazy paving”appearance. Biological work-up revealed regenerative normocytic normochromic anemia. Flexible bronchoscopy revealed diffuse 3rd-degree inflammation of the entire bronchial tract, with hyperhemic mucosa and no visible bleeding. On bronchoalveolar lavage (BAL), the alveolar fluid was unrepresentative, showing significant siderophagy. Immunological tests revealed positive anti MPO pANCA. Given that our patient had a five factor score (FFS) prognostic score for vasculitis of 0, she received Prednisolone : 1 mg/kg/d for 1 month, followed by a gradual decrease associated to Aziathioprine to prevent the progression of the disease. The evolution was marked by the cessation of haemoptysis and regression of anaemia.