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Microscopic polyangiitis with unusual lung involvement
Banu Eriş Gülbay1, Gökhan Celik, Ozlemözdemir Kumbasar
1Department of Pulmonary Diseases, Medical School of Ankara University, Turkey. banu.gulbay@gmail.com
Respirology (Carlton, Vic.)
|November 5, 2005
Summary
Microscopic polyangiitis (MPA) typically affects small vessels. This case highlights an unusual presentation of MPA with widespread nodular infiltration on imaging, leading to respiratory failure.
Area of Science:
- Rheumatology
- Nephrology
- Pulmonology
Background:
- Microscopic polyangiitis (MPA) is a systemic small vessel vasculitis.
- It is characterized by necrotizing glomerulonephritis without other small vessel involvement.
Observation:
- A patient presented with weakness, fever, and arthralgia.
- Chest X-ray (CXR) and thoracic CT revealed widespread nodular infiltration.
- Proteinase-3 anti-neutrophilic cytoplasmic antibody (c-ANCA) was positive, serum creatinine elevated, and hematuria developed.
Findings:
- Renal biopsy confirmed focal segmental necrotizing glomerulonephritis, consistent with MPA.
- The patient received high-dose corticosteroids and cyclophosphamide.
- Despite treatment, CXR worsened, leading to hypoxemia and mechanical ventilation.
Implications:
- Nodular infiltration is an uncommon radiological finding in MPA.
- This case underscores the importance of considering MPA in patients with atypical imaging findings.
- The patient ultimately succumbed to respiratory failure, emphasizing the severe potential complications of MPA.