• Sho Hamaguchi, Hitoshi Suzuki, Maki Hamaguchi, Masako Iwasaki, Hiromitsu Fukuda, Hisatsugu Takahara, Shigeki Tomita, and Yusuke Suzuki.
• Department of Nephrology Juntendo University Urayasu Hospital, Chiba, Japan.
• Medicine (Baltimore). 2022 Sep 2; 101 (35): e30416.

IntroductionAlveolar hemorrhage presents with severe respiratory failure, requiring prompt diagnosis and treatment. Alveolar hemorrhage is often caused by autoimmune diseases accompanied by progressive renal dysfunction. However, few cases without autoimmune diseases occur, making diagnosis difficult. Here, we report a case of alveolar hemorrhage with hypertensive emergency.Patient ConcernsA 28-year-old man presented with dyspnea and bloody sputum. His blood pressure was 200/120 mm Hg.DiagnosisThe chest computed tomography showed suggestive of alveolar hemorrhage. Renal dysfunction and proteinuria were observed. However, autoantibodies were not detected. Echocardiogram revealed left ventricular function decrease. Ejection fraction was 20% to 30% with no ventricular asynergy or any valvular diseases. Brain magnetic resonance imaging showed hyperintense lesions on fluid-attenuated inversion recovery in the white matter of both cerebral and right cerebellar hemispheres, which were compatible with posterior reversible encephalopathy syndrome. Renal biopsy did not reveal any immune-mediated glomerulonephritis or vasculitis, but hypertensive nephropathy was diagnosed.InterventionsBlood pressure was controlled with combination therapy using calcium channel blocker, angiotensin II receptor blocker, α1 blocker, and β blocker.OutcomesAlveolar hemorrhage and proteinuria improved with strict blood pressure control.ConclusionThis case indicates that severe hypertension can possibly cause alveolar hemorrhage. Accumulating these cases is important for general physicians to diagnose the alveolar hemorrhage with hypertensive emergency in its early stage and to avoid unnecessary treatment such as immunosuppressive therapy.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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