Microscopic polyangiitis initiated with liver dysfunction, calf pain and fever of unknown origin.
We report herein a case of microscopic polyangiitis (MPA), presenting onset with a spiking fever, liver/biliary dysfunction without jaundice and calf pain without elevation of serum creatine phosphokinase. During 1 month of careful examinations for initial diagnosis, the patient developed renal dysfunction and pulmonary hemorrhage. Based on the results of positive MPO-ANCA, renal and pulmonary involvements, the patient was diagnosed with MPA and treated with high-dose prednisolone and oral cyclophosphamide. Soon after initiation of the treatment, symptoms such as fever, calf pain, liver/biliary dysfunction and renal dysfunction disappeared with decrease of MPO-ANCA titer to the normal level.
Department of Rheumatology and Allergy, Research Hospital, Institute of Medical Science, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
Kei
K
Ohnuma
Osamu
O
Hosono
Tomoki
T
Katayose
Noritada
N
Yoshikawa
Hiroshi
H
Kawasaki
Takeshi
T
Fujii
Naoki
N
Oyaizu
Hirotoshi
H
Tanaka
Chikao
C
Morimoto
D000284:Administration, Oral; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood / Q000276:immunology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007866:Leg; D008107:Liver Diseases / Q000150:complications / Q000473:pathology*; D055953:Microscopic Polyangiitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D009195:Peroxidase / Q000097:blood / Q000276:immunology; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
D019268:Antibodies, Antineutrophil Cytoplasmic; D003520:Cyclophosphamide; D011239:Prednisolone; D009195:Peroxidase