Hemorrhagic and Interstitial Pneumonitis with Nephritis

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Abstract
The syndrome of hemorrhagic and interstitial pneumonitis with nephritis is reviewed and an additional case reported in whom a hypersensitivity state, involving primarily the lungs and kidneys, is believed to have existed. The role of an abnormal immunological reaction, in some cases perhaps to penicillin, in the production of the syndrome is discussed and comment made on the frequency of antecedent otological and nasal difficulty. The renal lesions at autopsy in these cases are indistinguishable from glomerulonephritis but the lungs reveal a characteristic picture, unlike that seen in uremia, of diffuse alveolar hemorrhage, thickened alveolar walls infiltrated by inflammatory cells, lining of hemorrhagic alveoli by cuboidal epithelium and evidence of connective tissue replacement of the hemorrhagic and inflammatory changes. The plugs of fibrous tissue in some alveoli, fibrous thickening of alveolar walls and intra-alveolar hemosiderin filled macrophages suggest chronicity and healing and raise the possibility of temporary recovery from this disorder though eventual death from renal insufficiency may be anticipated in those surviving the pulmonary hemorrhage because of the associated chronic nephritis.

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