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A case of microscopic polyangiitis in an elderly patient presenting predominantly with cholecystitis successfully
Kunihiro Ichinose1, Nozomi Iwanaga, Akitomo Okada
1Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
Abstract:
An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 μg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.
Insights
Microscopic polyangiitis (MPA) in an elderly patient presented as persistent cholecystitis. Treatment with prednisolone and mizoribine (MZR) effectively managed symptoms and reduced myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) levels.
Area of Science:
- Rheumatology
- Internal Medicine
- Pathology
Background:
- Microscopic polyangiitis (MPA) is a rare systemic vasculitis.
- MPA commonly affects small blood vessels, leading to organ damage.
- Diagnosis can be challenging, especially with atypical presentations.
Observation:
- An 82-year-old female presented with persistent cholecystitis unresponsive to antibiotics.
- Histopathology revealed periarterial vasculitis in the gallbladder.
- Elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers were detected.
Findings:
- The patient was diagnosed with microscopic polyangiitis (MPA).
- Initial treatment with prednisolone was partially effective but led to relapse upon tapering.
- Combination therapy with oral prednisolone and mizoribine (MZR) achieved sustained remission.
- Mizoribine (MZR) blood peak concentration was monitored and maintained effectively.
Implications:
- This case highlights MPA presenting predominantly as cholecystitis in an elderly patient.
- Successful management with oral prednisolone and mizoribine (MZR) offers a potential therapeutic strategy.
- Early diagnosis and tailored immunosuppressive therapy are crucial for favorable outcomes in MPA.
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