Pulmonary-renal syndrome in patients with incidental findings of infectious agents

Meregildo-Rodriguez E.D.; Tafur-Hoyos B.A.D.; Vásquez-Tirado G. · Boletin de Malariologia y Salud Ambiental (2022) · DOI: 10.52808/bmsa.7e6.625.006

Resumen

Pulmonary-renal syndrome (PRS) or reno-pulmonary syndrome is the combination of acute rapidly progressive glomerulonephritis (RPGNARP) and autoimmune diffuse alveolar hemorrhage (DAH). RPS was initially described by Goodpasture in the context of anti-glomerular basement membrane (GBM) syndrome. Currently, ANCA-associated vasculitides (AAV) explain 60% (range 56–77.5%) of cases, Goodpasture syndrome 15% (12.5–17.5%), and 10% of cases are due to other causes. PRS presents a wide clinical spectrum, from fulminant pulmonary capillaritis with ADH and acute respiratory failure, to subtler forms of disease that can only be detected by bronchoalveolar lavage (BAL). The objective of this study is to present the first Peruvian series of SPR associated with infectious agents. We report 3 cases, two corresponded to systemic lupus erythematosus and one to vasculitis associated with microscopic polyangiitis. The first case was associated with superinfection by C. tropicalis; the second case to A. fumigatus and C. albicans; and the third to infestation by A. lumbricoides. All cases occurred in women, required invasive ventilatory support and haemodialysis, and two were fatal. We conclude that SPR is a serious clinical condition commonly associated with superinfections or infestations, and that it carries high morbidity and mortality. Since there are no specific clinical features, a high index of suspicion is crucial. Relevant investigations—immunological tests, imaging tests, and skin, kidney, and/or lung biopsies—to specify the etiology should be carried out without delay, since early treatment can change the prognosis of these patients.

Instituciones: Universidad Privada Antenor Orrego; Universidad César Vallejo