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[A case of microscopic polyangitis presented with acute pericarditis]
Etsuko Asonuma1, Hideto Obata, Kozo Fujii
1Respiratory Division, Saiseikai Shimonoseki General Hospital.
Summary
Microscopic polyangitis can present with acute pericarditis and kidney failure. Early treatment with corticosteroids improved symptoms but opportunistic infection led to death.
Area of Science:
- Nephrology
- Rheumatology
- Cardiology
Background:
- Microscopic polyangitis (MPA) is a rare autoimmune vasculitis.
- MPA typically affects small blood vessels, leading to organ damage.
- Acute pericarditis is an unusual presentation of MPA.
Observation:
- A 75-year-old male with recurrent acute pericarditis presented with bilateral lung infiltrates, microhematuria, and renal failure.
- Serological testing revealed a positive MPO-ANCA (myeloperoxidase-antineutrophil cytoplasmic antibodies).
- Transbronchial and renal biopsies confirmed MPA with alveolar hemorrhage and crescentic glomerulonephritis.
Findings:
- Treatment with intravenous methylprednisolone followed by oral prednisolone led to resolution of lung infiltrates and improvement in renal function.
- Despite initial treatment success, the patient succumbed to an opportunistic infection 109 days after treatment initiation.
Implications:
- This case highlights the importance of considering MPA in patients with unexplained pericarditis and multi-organ involvement.
- Early diagnosis and immunosuppressive therapy are crucial for managing MPA.
- Opportunistic infections are a significant risk in immunocompromised patients treated for vasculitis.