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[Microscopic polyarteritis]

C de Ancos Aracil1, J L Rebollar Mesa

  • 1Servicio de Medicina Interna II, Hospital Universitario San Carlos, Madrid.

Anales De Medicina Interna (Madrid, Spain : 1984)
|September 1, 1995
PubMed
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Microscopic polyarteritis, a vasculitis causing glomerulonephritis, can present with alveolar hemorrhage. Early treatment with plasmapheresis, steroids, and cyclophosphamide showed improvement, though relapse occurred.

Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Microscopic polyarteritis is a systemic vasculitis associated with necrotizing glomerulonephritis.
  • It can affect renal and systemic levels, with alveolar hemorrhage occurring in a third of cases.

Observation:

  • A case presented with hemoptysis and progressive renal insufficiency.
  • Patient history included hypertension, hematuria, rhinitis, epistaxis, arthralgias, edema, dyspnea, paresthesias, and malaise.
  • Immunologic analysis revealed ANCA positivity with antimyeloperoxidase specificity; renal biopsy showed focal necrotizing glomerulonephritis.

Findings:

  • Diagnosis of microscopic polyarteritis was made due to intrapulmonary hemorrhage and identical renal damage to Wegener granulomatosis.
  • p-ANCA positivity confirmed the diagnosis in 99% of cases.

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  • Treatment with plasmapheresis, methylprednisolone, and cyclophosphamide led to initial improvement.

    • Implications:

    • Despite diagnostic challenges, the treatment for microscopic polyarteritis and Wegener granulomatosis is currently identical.
    • Early intervention is crucial for managing this condition.
    • The case highlights the importance of considering microscopic polyarteritis in patients with unexplained hemoptysis and renal failure, even with atypical presentations.