title: [A case of microscopic polyangitis with sepsis due to pyelonephritis].
abstract: A 69-year-old woman, who had been diagnosed with interstitial pneumonia at 66 years of age, was admitted to our hospital because of high fever, purpura occurring on her arms and legs, and renal dysfunction. At the time of admission, her renal function had severely deteriorated (sCr 8.2 mg/dl, 24 h Ccr 6 ml/min), she had a severe high fever (BT 39.5 degrees C), back pain, a white blood cell count of 19,540/,microl, and a CRP level of 26.7 mg/dl. Blood and urine cultures yielded identical strains of E. coli. We diagnosed sepsis caused by pyelonephritis, and started intravenous meropenem trihydrate(MEPM) at 0.5 g/day. Her renal dysfunction was severe, so we started hemodialysis therapy. Immunological examination revealed the presence of ANCA-associated glomerulonephritis. Renal biopsy before steroid therapy confirmed the diagnosis of pauci-immune-type crescentic glomerulonephritis. Based on purpura and interstitial pneumonia, along with rapidly MPO-ANCA-positive progressive glomerulonephritis (RPGN) with acute renal failure, we diagnosed microscopic polyangitis (MPA). To treat sepsis and severe pyelonephritis, we started intravenous immunoglobulin 5 g (100 mg/kg)/day for 5 days before starting immunosuppressive steroid therapy (m-PSL 1 g/day, PSL 20 mg/day) for 3 days. These treatments improved her general condition and immediately improved her renal function. It is important to prevent infection during treatment using conventional immunosuppressive therapy. These findings suggest immunoglobulin therapy to be a safe immuno-suppressive treatment that is efficacious against ANCA-associated glomerulonephritis.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Chiari
authors.initials: C
authors.lastname: Kojima
authors.forename: Wako
authors.initials: W
authors.lastname: Yumura
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Itabashi
authors.forename: Masae
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Shunji
authors.initials: S
authors.lastname: Shiohira
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Yabuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Takei
authors.forename: Keiko
authors.initials: K
authors.lastname: Uchida
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D009195:Peroxidase / Q000276:immunology; D011704:Pyelonephritis / Q000150:complications* / Q000276:immunology; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology*; D014657:Vasculitis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007074:Immunoglobulin G; D007155:Immunologic Factors; D009195:Peroxidase