Patient with haemoptysis, shortness of breath and microscopic haematuria.

Forty three years old male from Dhule district of Maharashtra presented to his family doctor in December 2004 with malaise, anorexia, haemoptysis. After baseline x-ray (Figure 1) and blood tests he was started on anti tuberculosis treatment (ATT). Patient kept getting recurrent haemoptysis for which repeated x-ray chest were performed (Figure 2). In January 2006 he got admitted to our hosp i ta l wi th haempotys i s a n d b r e a t h l e s s n e s s . O n examination, pulse-96/min, b l o o d p r e s s u r e 1 8 0 / 1 0 0 , respiratory rate20/ min, he was pale , had no oedema, raised jugular venous pressure o r c ya n o s i s . T h e r e w e r e b i la tera l f ine crepi ta t ions on auscultation of chest, no gallop or any organomegaly was present. As per his old records his serum creatinine in August 2005 was 2mg/dl. His investigations at our hospital were as follows: Hemoglobin4.5gm/dl, WBC12000/cumm, Erythrocute Sedimentation Rate115mm at 1 hour, Urine Patient with Haemoptysis, Shortness of Breath and Microscopic Haematuria