Pulmonary Hemosiderosis and Glomerulonephritis

Abstract

This paper reports 3 adult patients with pulmonary hemosiderosis and glomerulonephritis, and reviews the literature on this unusual combination. In each instance, the patient was a previously healthy, white male in his 20''s, in whom the initial manifestation was recurrent hemoptysis followed by severe hypochromic anemia. In the first patient, hematuria was not noted until three weeks after the onset of hemoptysis. Azotemia appeared only after five and one-half months had elapsed. The second patient had an 11-month course of intermittent hemoptysis before the terminal illness. The third patient presented with a history of repeated bouts of hemoptysis of three weeks'' duration. On admission he had hematuria. He died of renal failure after a five week illness. The significant pathological findings in all three patients were quite similar and were limited to the lungs and kidneys. In each, the lungs showed extensive, patchy intra-alveolar hemorrhage, alveolar hemosiderosis, focal chronic organizing alveolitis, and interstitial pneumonitis. The histopathology of the kidney lesions appeared to be more specific than the changes in the lung. A diffuse, necrotizing glomerulonephritis was found, and the glomeruli, like the lung, showed acute, subacute, and chronic changes. The relationship between the syndrome of pulmonary hemosiderosis and glomerulonephritis as described in this paper, these diseases with clinical and pathological similarities, and those patients with only "idiopathic pulmonary hemosiderosis" is uncertain. Further studies of similar patients may lead to a better understanding of the etiological factors.