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Microscopic polyangiitis masquerading as a pancreatic neoplasm with multiple lung metastases
Manami Suzuki1, Hideki Okata2, Hanae Sakata1
1Internal Medicine, South Miyagi Medical Center, Ogawara, Japan.
BMJ Case Reports
|August 23, 2019
Summary
A rare case of pancreatic cancer initially presenting with severe glomerulonephritis and polyangiitis showed remarkable tumor regression and renal function improvement with immunosuppressive therapy.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Pancreatic cancer can present with paraneoplastic syndromes.
- Rapidly progressive glomerulonephritis (RPGN) is a severe renal disease often associated with systemic vasculitis.
Observation:
- A 71-year-old man presented with abdominal pain, elevated tumor markers, and CT findings suggestive of pancreatic cancer with lung metastases.
- The patient rapidly developed acute kidney injury with urine abnormalities, and testing revealed positive myeloperoxidase-antineutrophil cytoplasmic antibodies, indicating microscopic polyangiitis and RPGN.
Findings:
- Treatment with high-dose glucocorticoids and cyclophosphamide led to the regression of the pancreatic tumor and lung nodules.
- Renal function improved significantly, avoiding the need for long-term dialysis.
Implications:
- This case highlights the importance of considering systemic autoimmune diseases in patients with suspected malignancy and unusual presentations.
- Aggressive immunosuppressive therapy may lead to favorable outcomes in pancreatic cancer patients with co-existing RPGN and vasculitis.
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