Pulmonary capillaritis in IgA nephropathy.

Pulmonary capillaritis presenting as diffuse alveolar hemorrhage is a rare manifestation in patients with IgA nephropathy. A 20-year-old male with hemodialysis dependent, end-stage renal failure presented with recurrent hemoptysis and respiratory failure. A histologic diagnosis of pulmonary capillaritis was established by transbronchial lung biopsy. He was successfully treated with intravenous methylprednisone and plasma exchange followed by oral prednisone and cyclophosphamide. This report highlights the independent renal and pulmonary manifestations of IgA nephropathy and the management of the resultant diffuse alveolar hemorrhage with aggressive immunosuppression.