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Hepatitis B-Related Polyarteritis Nodosa Complicated by Pulmonary Hemorrhage*

Xiaoqing Guo, MD; Ramprasad Gopalan, MD; Steve Ugbarugba, MD; Harold Stringer, MD; Michael Heisler, MD; Marilyn Foreman, MD, FCCP; Chike Nzerue, MD
Author and Funding Information

*From the Department of Internal Medicine (Drs. Guo, Gopalan, Ugbarugba, Stringer, and Heisler), the Section of Pulmonary/Critical Care (Dr. Foreman), and Renal Service (Dr. Nzerue), Morehouse School of Medicine, Atlanta, GA.

Correspondence to: Chike Nzerue, MD, Renal Service, Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310; e-mail: Cmnzerue@aol.com



Chest. 2001;119(5):1608-1610. doi:10.1378/chest.119.5.1608
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A 34-year-old man presented with fever, weight loss, paresthesia, abdominal pain, and hypertension. He had hepatitis B antigenemia, with negative antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane serology results. Renal arteriography showed multiple intrarenal microaneurysms. In spite of therapy with antiviral agents (lamivudine, famciclovir), prednisone, cyclophosphamide, and plasmapheresis, renal function deteriorated. He later developed rapidly progressive dyspnea and hemoptysis. Diffuse alveolar hemorrhage was confirmed by bronchoscopy. He died of respiratory failure. The cause of pulmonary hemorrhage in this case of polyarteritis nodosa is unclear, but may include underlying capillaritis, cocaine-induced pulmonary hemorrhage, or recurrent attacks of malignant hypertension.

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