A case of myeloperoxidase-antineutrophil cytoplasmic antibody positive-polyarteritis nodosa complicated by interstitial pneumonia and rapidly progressive renal failure.
A 73-year-old woman was admitted to our hospital because of persistent high fever and cough, generalized myalgia, and renal dysfunction. Laboratory examination revealed severe inflammatory signs, pulmonary fibrosis, progression of renal impairment with active nephritic urinary sediments, and a high titer of myeloperoxidase-antineutrophil cytoplasmic antibody, indicating that she might have microscopic polyangiitis with interstitial pneumonia and rapidly progressive glomerulonephritis. Her renal biopsy, however, showed tubulointerstitial changes with mild glomerular abnormalities, and renal angiography revealed that she had vascular lesions of medium-sized arteries, which were compatible with classical polyarteritis nodosa. Tissue biopsy of the clinically affected organ should be considered in anyone suspected to have vasculitis.
Sugimoto
Toshiro
T
Department of Medicine, Shiga University of Medical Science, Seta, Otsu, 520-2192, Japan. toshiro@belle.shiga-med.ac.jp
Kanasaki
Keizo
K
Koyama
Tetsuro
T
Yokomaku
Yukiyo
Y
Yasuda
Hitoshi
H
Kashiwagi
Atsunori
A
Koya
Daisuke
D
D000368:Aged; D000792:Angiography; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001379:Azathioprine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000098:blood supply*; D017563:Lung Diseases, Interstitial / Q000150:complications*; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*
D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine