A rise in antineutrophil cytoplasmic antibody in a patient with systemic vasculitis in remission.
We report a 42-year-old man who showed alveolar hemorrhage and glomerulonephritis as well as episcleritis and skin rash. He had an extremely high titer of cytoplasm-staining antineutrophil cytoplasmic antibody (C-ANCA) and was diagnosed as having systemic vasculitis based on histological findings of kidney and skin biopsies. After immunosuppressive therapy clinical manifestations resolved within several weeks and C-ANCA titers commensurably declined. C-ANCA titers, however, increased again and remained high despite clinical remission. In general, there is a close relationship between ANCA titers and clinical activities in ANCA-associated diseases, but they displayed a large discrepancy in this patient. Indeed, the serum of the patient in remission contained the antibody against 29-kD neutrophil extracts which was detected by immunoblot analysis. These findings suggest that C-ANCA may not necessarily be, by itself, pathogenetic for the development of the vasculitis.
Fourth Department of Internal Medicine, University of Tokyo Faculty of Medicine, Japan.
S
S
Kaname
S
S
Uchida
S
S
Minoda
Y
Y
Arimura
T
T
Nagasawa
S
S
Asano
E
E
Ogata
D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers; D001706:Biopsy; D004797:Enzyme-Linked Immunosorbent Assay; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006801:Humans; D015151:Immunoblotting; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008297:Male; D012074:Remission Induction
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents