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The confirmation bias is the tendency to focus on information that confirms our existing beliefs and ignore information that is inconsistent with our expectations. For example, if you think that your professor is not very nice, you notice all of the instances of rude behavior exhibited by the professor while ignoring the countless pleasant interactions he is involved in on a daily basis. Have you ever fallen prey to the confirmation bias, either as the source or target of such bias?
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A Standardized Liquid Biopsy Preanalytical Protocol for Downstream Circulating-Free DNA Applications
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Microscopic polyangiitis presented with biopsy-confirmed pleuritis.

Naoto Ishimaru1, Hisashi Ohnishi, Mao Fujii

  • 1Akashi Medical Center, Department of General Internal Medicine. maru-tkb@umin.ac.jp.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|June 22, 2018
PubMed
Summary

Microscopic polyangiitis can present as pleuritis, a rare manifestation. Intravenous immunoglobulin effectively treated this patient

Keywords:
Microscopic polyangiitispleuritisthoracoscopy.

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Area of Science:

  • Pulmonology
  • Nephrology
  • Rheumatology

Background:

  • Microscopic polyangiitis (MPA) is a rare systemic vasculitis.
  • MPA commonly affects the lungs and kidneys.
  • Pleural involvement in MPA is uncommon.

Purpose of the Study:

  • To report a case of MPA presenting as pleuritis.
  • To highlight the diagnostic challenges and treatment of MPA with pleural involvement.

Main Methods:

  • Case report of an 80-year-old male.
  • Diagnostic workup included chest radiography, thoracentesis, and thoracoscopic biopsy.
  • Serological tests for anti-neutrophil cytoplasmic antibodies (ANCA) were performed.
  • Treatment response to pulse steroid therapy and intravenous immunoglobulin (IVIG) was assessed.

Main Results:

  • Patient presented with shortness of breath and cough, with radiographic evidence of bilateral lung opacities and pleural effusion.
  • Thoracentesis revealed lymphocytic exudates, and biopsy showed fibrotic pleuritis.
  • Rapidly progressive glomerulonephritis and elevated myeloperoxidase (MPO)-ANCA titers were observed.
  • The patient was refractory to pulse steroid therapy but responded well to a five-day course of IVIG.

Conclusions:

  • MPA should be considered in the differential diagnosis of pleuritis, especially in elderly patients with unexplained respiratory and renal symptoms.
  • Thoracoscopic biopsy is crucial for confirming pleural involvement in MPA.
  • Intravenous immunoglobulin can be an effective treatment option for MPA refractory to conventional therapies.