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February 2001: A 74 year old man with a history over 3 months of increasing dyspnea and malaise

L Baldwin1, D Poller, D Ellison

  • 1Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK.

Brain Pathology (Zurich, Switzerland)
|June 21, 2001
PubMed

Insights

A 78-year-old man with cerebellar ataxia developed kidney failure and spinal hemorrhage due to microscopic polyangiitis, an autoimmune disorder causing blood vessel inflammation.

Area of Science:

  • Nephrology
  • Neurology
  • Rheumatology

Background:

  • Idiopathic late-onset cerebellar ataxia can present with multisystemic complications.
  • Renal failure and neurological events necessitate a thorough differential diagnosis.

Observation:

  • A 78-year-old male with cerebellar ataxia presented with acute renal failure, elevated ESR, and positive pANCA.
  • The patient developed a subclinical spinal subarachnoid hemorrhage and renal cortical infarcts.

Findings:

  • Histopathology revealed necrotizing inflammation in leptomeningeal vessels and renal arteries.
  • Autoantibody screening supported a diagnosis of microscopic polyangiitis.

Implications:

  • Microscopic polyangiitis should be considered in the differential diagnosis of unexplained renal failure and neurological complications.
  • This case highlights the rare association of spinal subarachnoid hemorrhage with vasculitis.

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