A unique case of indolent microscopic polyangiitis in an elderly gentleman: a case report and brief review

Clement Tan, Jithmy Perara, Pranav Kumar

Abstract


Antineutrophil cytoplasmic autoantibody associated vasculitides has 3 different types: Granulomatosis with polyangiitis, eosinophilic granulomatosis and polyangiitis and microscopic polyangiitis. These vasculitides manifest differently based on which area of small and medium size vessels in our bodies that it affects. In this case report, we discuss a unique case of microscopic polyangiitis diagnosed in a 75-year-old male who was relatively asymptomatic i.e. indolent, apart from nodules present in the lung with the use of the diagnostic criteria outlined by 2022 American College of Rheumatology and European Alliance of Associations for Rheumatology. In addition, we reviewed briefly about vasculitis, its epidemiology and the workup of microscopic polyangiitis.

Keywords


Vasculitis; Antineutrophil cytoplasmic autoantibody; ANCA associated vasculitis; Microscopic polyangiitis; Indolent vasculitis; Granulomatosis with polyangiitis; Eosinophilic granulomatosis and polyangiitis; Renal biopsy

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References


Hunter RW, Welsh N, Farrah TE, Gallacher PJ, Dhaun N. ANCA associated vasculitis. BMJ. 2020;369:m1070. doi: 10.1136/bmj.m1070. PMID: 32291255; PMCID: PMC7179255.

Yates M, Watts R. ANCA-associated vasculitis. Clin Med (Lond). 2017;17(1):60-64. doi: 10.7861/clinmedicine.17-1-60. PMID: 28148583; PMCID: PMC6297586.

Hashmi MF, Jain V, Tiwari V. Microscopic Polyangiitis. StatPearls. Treasure Island (FL): StatPearls Publishing. 2023, StatPearls Publishing LLC.; 2023.

Gagnier JJ, Kienle G, Altman DG, et al. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med. 2013;2(5):38-43. doi: 10.7453/gahmj.2013.008. PMID: 24416692; PMCID: PMC3833570.

Suppiah R, Robson JC, Grayson PC, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis. Ann Rheum Dis. 2022;81(3):321-326. doi: 10.1136/annrheumdis-2021-221796. PMID: 35110332.

Gatenby PA. Unusually indolent MPO-ANCA: associated vasculitis-report of two cases. CEN Case Rep. 2013;2(2):131-133. doi: 10.1007/s13730-012-0045-y. PMID: 28509287; PMCID: PMC5413649.

Hauer HA, Bajema IM, van Houwelingen HC, et al. Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups. Kidney Int. 2002;61(1):80-9. doi: 10.1046/j.1523-1755.2002.00089.x. PMID: 11786087.

Bajema IM, Hagen EC, Hermans J, et al. Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis. Kidney Int. 1999;56(5):1751-8. doi: 10.1046/j.1523-1755.1999.00758.x. PMID: 10571783.

Franssen C, Gans R, Kallenberg C, Hageluken C, Hoorntje S. Disease spectrum of patients with antineutrophil cytoplasmic autoantibodies of defined specificity: distinct differences between patients with anti-proteinase 3 and anti-myeloperoxidase autoantibodies. J Intern Med. 1998;244(3):209-16. doi: 10.1046/j.1365-2796.1998.00357.x. PMID: 9747743.

Smyth L. ANCA-associated vasculitis Australian Clinical Labs: Australian Clinical Labs Media Releases; 2016 [https://www.clinicallabs.com.au/about-us/doctor-media-releases/anca-associated-vasculitis/ available at 12/13/2023]

Drooger JC, Dees A, Swaak AJ. ANCA-Positive Patients: The Influence of PR3 and MPO Antibodies on Survival Rate and The Association with Clinical and Laboratory Characteristics. Open Rheumatol J. 2009;3:14-7. doi: 10.2174/1874312900903010014. PMID: 19461938; PMCID: PMC2684710.

Watts RA, Hatemi G, Burns JC, Mohammad AJ. Global epidemiology of vasculitis. Nat Rev Rheumatol. 2022;18(1):22-34. doi: 10.1038/s41584-021-00718-8. PMID: 34853411; PMCID: PMC8633913.

Lionaki S, Blyth ER, Hogan SL, et al. Classification of antineutrophil cytoplasmic autoantibody vasculitides: the role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis. Arthritis Rheum. 2012;64(10):3452-62. doi: 10.1002/art.34562. PMID: 23023777; PMCID: PMC3462364.

Redondo-Rodriguez R, Mena-Vázquez N, Cabezas-Lucena AM, et al. Systematic Review and Metaanalysis of Worldwide Incidence and Prevalence of Antineutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis. J Clin Med. 2022;11(9):2573. doi: 10.3390/jcm11092573. PMID: 35566698; PMCID: PMC9106044.

Almaani S, Fussner LA, Brodsky S, Meara AS, Jayne D. ANCA-Associated Vasculitis: An Update. J Clin Med. 2021;10(7):1446. doi: 10.3390/jcm10071446. PMID: 33916214; PMCID: PMC8037363.

Comarmond C, Crestani B, Tazi A, et al. Pulmonary fibrosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis: a series of 49 patients and review of the literature. Medicine (Baltimore). 2014;93(24):340-349. doi: 10.1097/MD.0000000000000217. Erratum in: Medicine (Baltimore). 2014;93(24):414. Erratum in: Medicine (Baltimore). 2015;94(2):1. PMID: 25500703; PMCID: PMC4602438.

Ando M, Miyazaki E, Ishii T, et al. Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis. Respir Med. 2013;107(4):608-15. doi: 10.1016/j.rmed.2013.01.006. PMID: 23434037.




DOI: http://dx.doi.org/10.22551/2023.41.1004.10276

Copyright (c) 2023 Clement Tan, Jithmy Perara, Pranav Kumar

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ISSN: 2360-6975