Addressing inflow to the lower extremities is fundamental to the management of peripheral arterial disease, since without inflow infrainguinal procedures are destined to fail. Funding Statement Funding/Support: The authors have no funding disclosures. Footnotes Conflict of Interest Disclosure: All authors have completed and submitted the Methodist DeBakey Cardiovascular

Journal Conflict of Interest Statement and none were reported. Contributor Information Jean Wortmannin Bismuth, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas. Cassidy Duran, Methodist DeBakey Heart & Vascular Center, Inhibitors,research,lifescience,medical The Methodist Hospital, Houston, Texas.

Introduction Pulmonary renal syndromes are classically associated with systemic vasculitis and autoimmune disorders, such as systemic lupus erythematosus and Goodpasture syndrome. The dramatic presentation of pulmonary

hemorrhage in conjunction with new onset renal insufficiency as presented in this case naturally led to the search Inhibitors,research,lifescience,medical for primary pulmonary renal syndrome. Interestingly, Inhibitors,research,lifescience,medical the patient was found to have a new diagnosis of multiple myeloma presenting with symptoms of hemoptysis and acute renal failure. The constellation of pulmonary renal symptoms seen in this case is extremely rare in association with multiple myeloma; specifically, only one other case has been reported with similar presenting symptoms. This article reviews and discusses a case of pulmonary renal syndrome related to multiple myeloma. A review of the current literature of pulmonary renal syndrome in multiple myeloma is also presented. Inhibitors,research,lifescience,medical Case Presentation A 67-year-old Caucasian male with past medical history notable only for hypertension and osteoarthritis presented with symptoms of cough and Inhibitors,research,lifescience,medical shortness of breath. The patient was in good health overall. Of note, approximately 2 weeks prior to admission, the patient

had gone fishing and was accidentally stuck in the hand with a catfish fin. He subsequently developed mild cellulitis around the lesion and was treated with trimethoprim-sulfamethoxazole (TSM) and cephalexin. Approximately 1 week prior to admission, he developed progressive shortness of breath and nonproductive cough, prompting admission to the hospital. He denied any fever, weight changes, or other constitutional symptoms. However, the dyspnea became progressively more debilitating over the course of days, with pronounced malaise. His clinical (-)-p-Bromotetramisole Oxalate condition rapidly deteriorated as he developed hypoxia and hemoptysis, requiring intubation and intensive care unit monitoring. His past medical history was unremarkable except for hypertension, and he denied tobacco, alcohol, or illicit drug use. Home medications included only lisinopril and the recently prescribed antibiotics. On physical examination, the patient was well-nourished (BMI 28.8 kg/m2), intubated, and sedated.