A Case of Pulmonary Renal Syndrome, Initially Diagnosed as Pneumonia

of 18F-FDG with the SUV value of 4 to 6 at the sternum, vertebra and ilium (in addition to the lung and kidney. There was no evidence of osteolysis.) Cytological analysis of sputum, pleural effusion, and urine indicated the diagnosis of urothelial carcinoma with lung metastasis. The serum GCSF concentration was 220 pg/ml, and the white blood cell count increased to 71,400/μl by the 22 day of admission when he died. Necropsy confirmed the diagnosis of primary urothelial carcinoma of the left renal pelvis and its lung metastasis. The specimen was immunohistochemically positive for G-CSF production. Bone marrow examination did not reveal any malignancy. Discussion: The leukocytosis seems to have been caused by ectopic production of G-CSF from the urothelial carcinoma. In general, GCSF producing urothelial carcinoma is diagnosed at late stages. In the present case, in particular, the remarkable presentation as multiple lung lesions with cavitation mimicking pulmonary tuberculosis caused a delay in the diagnosis.