Description

A 60-year-old woman, who was previously diagnosed with vasculitis on skin biopsy after developing maculopapular rash on lower extremities, presented with worsening dyspnoea, cough, blood-tinged sputum and night sweats. At emergency department , she was tachycardic and tachypneic with SpO₂ of 86%. Arterial blood gas showed a pH of 7.45, pCO₂ 36 mm Hg, pO₂ 55.4 mm Hg, bicarbonate 25.0 mmol/L, SaO₂ 83.5%, and complete blood count revealed a white cell count of 24.9 K/μL and Hb 8.9 g/dL, which dropped down to 7.2 g/dL over the next 24 h (figure 1). Chest X-ray showed bilateral airspace opacities (figure 2) and the following CT scan demonstrated severe central pneumonitis consistent with alveolar haemorrhage (figure 3A,B). For respiratory failure, she was intubated, and bronchoscopic examination showed fresh blood in the right middle lobe without identified bleeding sites. Differential cell counts of bronchoalveolar lavage revealed eosinophils …