title: A Case Report Describing a Rare Presentation of Simultaneous Occurrence of MPO-ANCA-Associated Vasculitis and Rheumatoid Arthritis.
abstract: Background. Renal-limited myeloperoxidase vasculitis with simultaneous rheumatoid arthritis is reported as a rare occurrence. Review of literature suggests that most patients had a diagnosis of rheumatoid arthritis for several years prior to presenting with renal failure from myeloperoxidase vasculitis.Case Presentation. A 58-year-old Caucasian male presented to the hospital experiencing malaise, fevers, decreased oral intake, nausea, and vomiting for one week duration. His past medical history consisted of newly diagnosed but untreated rheumatoid arthritis, hypertension, and non-insulin-dependent diabetes mellitus. He was found to have acute renal failure, proteinuria, and hypoglycemia. Standard therapy, including intravenous fluids, did not improve his acute renal failure. A vasculitis workup resulted in a positive myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). Renal biopsy revealed crescentic glomerulonephritis (GN) pauci-immune type, suggestive of MPO-ANCA-associated vasculitis (MPO-AAV). Treatment consisted of prednisone, cyclophosphamide, and seven cycles of plasmapheresis, in addition to hemodialysis for uremia. Upon discharge, he received hemodialysis for another week and continued treatment with cyclophosphamide and prednisone.Conclusion. Patients with longstanding rheumatoid arthritis may develop renal failure due to nonsteroidal anti-inflammatory medication use and AA type amyloidosis; however, necrotizing glomerulonephritis with crescent formation has been rarely reported. This stresses the importance of early recognition and swift initiation of treatment.
authors.affiliation: Department of Internal Medicine, Southern Illinois University, 751 North Rutledge, Springfield, IL 62702, USA.
authors.forename: Nathalie
authors.identifier: 0000-0003-1261-6454
authors.initials: N
authors.lastname: Foray
authors.affiliation: Department of Internal Medicine, Southern Illinois University, 751 North Rutledge, Springfield, IL 62702, USA.
authors.forename: Tamer
authors.identifier: 0000-0001-6984-9860
authors.initials: T
authors.lastname: Hudali
authors.affiliation: Department of Internal Medicine, Southern Illinois University, 751 North Rutledge, Springfield, IL 62702, USA.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Papireddy
authors.affiliation: Department of Pathology, Memorial Medical Center, 701 North 1st Street, Springfield, IL 62781, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gao