Malignant hypertension with a rare complication of pulmonary alveolar hemorrhage

A 34-year-old Japanese male was admitted to Okayama University Hospital wit h severe hypertension, rapidly progressive renal failure, blurred vision, d yspnea and hemoptysis. Clinical diagnosis of malignant hypertension was giv en and antihypertensive therapy and hemodialysis were immediately started. Renal biopsy was performed on the sixth day in hospital to examine the unde rlying disease, such as microscopic form of polyarteritis, since the compla int of hemoptysis and pulmonary alveolar hemorrhage was noted by computed t omography of the lungs. Typical pathological changes of malignant hypertens ion, i.e. fibrinoid necrosis of the afferent arterioles and proliferative e ndoarteritis at the interlobular arteries were observed. There was no evide nce of active necrotizing glomerulonephritis and crescent formation. Renal function was gradually recovered and pulmonary hemorrhage completely disapp eared by treatment with antihypertensive agents. The authors report a case of malignant hypertension with a rare complication of pulmonary alveolar he morrhage and speculate that it may be related to vascular injuries at the a lveolar capillary level caused by malignant hypertension. Copyright (C) 200 0 S. Karger AG, Basel.