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Acute on chronic subdural hematoma as a rare complication in a microscopic polyangiitis patient receiving

N Takahashi1, H Kimura, R Kitai

  • 1Department of General Medicine, Division of Nephrology, School of Medicine, Faculty of Medical Sciences, University of Fukui, Japan.

Clinical Nephrology
|September 19, 2009
PubMed

Insights

Microscopic polyangiitis (MPA) can rarely lead to acute subdural hematoma (SDH). Early symptoms like headaches in MPA patients, especially those on antithrombotics, warrant close attention.

Area of Science:

  • Nephrology
  • Neurology
  • Rheumatology

Background:

  • Microscopic polyangiitis (MPA) is a systemic vasculitis often affecting the kidneys.
  • Chronic subdural hematoma (SDH) is a collection of blood in the subdural space, typically associated with head trauma or anticoagulation.

Observation:

  • A 56-year-old male with MPA presented with elevated myeloperoxidase antineutrophil cytoplasmic antibody (MPOANCA) and acute renal dysfunction.
  • Renal biopsy revealed crescentic glomerulonephritis (GN) with membranous nephropathy (MN).

Findings:

  • The patient developed an acute exacerbation of a chronic subdural hematoma (SDH) during treatment for MPA.
  • Autopsy confirmed vasculitis scars in the leptomeninges, kidney, and lung.

Implications:

  • Subdural hematoma is a rare but serious complication of microscopic polyangiitis.
  • Nephrologists should monitor for neurological symptoms, particularly headaches, in MPA patients on antithrombotic therapy due to the risk of SDH.

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