title: Delayed ANCA positivity in pulmonary-renal syndrome.
abstract: A 57-year-old man was admitted due to rapidly progressive renal failure and pulmonary edema. Chest X-ray showed a bilateral lung infiltrate, while a normal myocardial contractility was reported by echocardiography. Though initially ANCA were absent, a necrotizing vasculitis with polymorphonuclear leukocyte infiltrate was observed in a kidney biopsy specimen. Renal histology was compatible with microscopic polyangiitis because of necrotizing lesions located at small vessels and at glomeruli that were not crescentic. Corticosteroids and immunosuppressive treatment was played with significant clinical improvement. Six months later, the patient died of a gastrointestinal hemorrhage due to bowel perforation by vasculitic lesion. This time high p-ANCA positivity was detected and at renal histology crescentic glomeruli were observed.
authors.affiliation: Emergency Department, University La Sapienza, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Nocente
authors.forename: N
authors.initials: N
authors.lastname: Gentiloni Silveri
authors.forename: G
authors.initials: G
authors.lastname: Bertazzoni
authors.forename: M
authors.initials: M
authors.lastname: Ceccanti
authors.forename: G F
authors.initials: GF
authors.lastname: Zannoni
authors.forename: R
authors.initials: R
authors.lastname: Manna
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D017809:Fatal Outcome; D006801:Humans; D007674:Kidney Diseases / Q000276:immunology* / Q000473:pathology; D008171:Lung Diseases / Q000276:immunology*; D008297:Male; D009336:Necrosis; D013997:Time Factors; D014657:Vasculitis / Q000276:immunology* / Q000473:pathology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic