A 54-year-old Indian female presented to the hospital with a 4-day history of
fever,
shortness of breath and blood-streaked sputum. Chest radiograph showed consolidation and she was admitted as a case of bilateral
bronchopneumonia. She was started on broad-spectrum
antibiotics and
antivirals but she continued to deteriorate clinically with increasing
oxygen requirement and worsening lung infiltrates. Since lab investigations also revealed significant anaemia and renal impairment, vasculitic workup for pulmonary renal haemorrhagic syndrome was ordered even though she had no haemoptysis in the hospital and haemoglobin was stable after initial
blood transfusion. High-resolution computed tomography scan was done on day 5 to assess progression and for any clue to diagnosis. It showed extensive bilateral air space consolidation and ground-glass opacities with suggested radiological differential diagnosis of cryptogenic organising
pneumonia or pulmonary haemorrhage. Pulmonology team did not recommend bronchoscopy at the time.In view of the clinical features of rapidly progressing
pneumonia despite standard treatment, history of haemoptysis, anaemia, renal impairment and CT scan findings suggestive of pulmonary haemorrhage, pulse intravenous
Methylprednisolone was initiated. The patient showed marked clinical and radiological improvement. The vasculitic workup later revealed positive
myeloperoxidase antibody and a definitive diagnosis of
microscopic polyangiitis was made. She was discharged in a stable condition and advised to follow-up in rheumatology where she continues to follow-up 2 years after her initial diagnosis.This is the first case reported in literature, where treatment was initiated for this
rare disease entity within a week of presentation based on highly suggestive clinical, laboratory and radiological evidence without waiting for a confirmatory diagnosis. Delay in this rapidly deteriorating patient could have been fatal and our prompt action was crucial in securing a favourable outcome.