pANCA-vasculitis associated with rectal adenocarcinoma

Area of Science:

• Nephrology
• Rheumatology
• Oncology

Background:

• Vasculitis, particularly anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, can present with diverse systemic symptoms.
• The association between malignancy and vasculitis, whether as a paraneoplastic syndrome or independent disease, requires careful evaluation.

Observation:

• A 69-year-old male presented with constitutional symptoms, respiratory issues, and neurological deficits indicative of mononeuritis multiplex.
• Diagnosis revealed myeloperoxidase (MPO)-ANCA-associated vasculitis concurrently with rectal adenocarcinoma.
• Initial treatment involved surgical resection of the tumor.

Findings:

• Vasculitis recurrence during corticosteroid tapering necessitated the addition of Mycophenolate mofetil.
• Combination therapy led to complete remission of vasculitis symptoms.
• The clinical course suggested vasculitis as an independent entity rather than a paraneoplastic phenomenon.

Implications:

• This case underscores the importance of considering ANCA serologies in diagnosing and monitoring vasculitis, especially in patients with malignancy.
• It highlights the potential for vasculitis to occur independently of cancer, requiring specific immunosuppressive treatment.
• Management strategies may involve a multidisciplinary approach combining oncological and rheumatological interventions.