Fever, renal failure, and diffuse alveolar hemorrhage: Unraveling the ANCA vasculitis connection.
Background: Microscopic polyangiitis (MPA), a small-vessel antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, may present insidiously with prolonged fever, renal dysfunction, and pulmonary infiltrates--often mimicking infections, especially in tropical settings. Case presentation: A 6...
| Publicado en: | Critical Care & Shock Vol. 28; no. 6; pp. 279 - 287 |
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| Autores principales: | , , , |
| Formato: | case study diagnostic images tables/charts Journal Article |
| Publicado: |
Critical Care & Shock Journal
2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=189673560&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 189673560 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14107767 6CKO jtl: Critical Care & Shock issn: 14107767 maglogo: N pubinfo: dt: 2025 vid: 28 iid: 6 pid: 45459 pub: Critical Care & Shock Journal place: Houston, Texas artinfo: ui: 189673560 189673560 189673560 189673560 ppf: 279 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Fever, renal failure, and diffuse alveolar hemorrhage: Unraveling the ANCA vasculitis connection. aug: au: Gandikota, Prathyusha Narayanasamy, Senthil Chenguttuvan, Avinash Pandurangan, Viswanathan affil: Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India sug: subj: Microscopic Polyangiitis Radiography Microscopic Polyangiitis Therapy Fever Etiology Renal Insufficiency Etiology Hemorrhage Etiology Antibodies, Antineutrophil Cytoplasmic Analysis Vasculitis Chemically Induced Male Middle Age Comorbidity Dyspnea Etiology Fatigue Etiology Edema Etiology Autoimmune Diseases Critical Care Immunosuppressive Agents Therapeutic Use Vasculitis Immunology Biopsy Methods Tomography, X-Ray Computed Bronchoscopy Steroids Administration and Dosage Administration, Oral Hemodialysis Middle Aged: 45-64 years Male ab: Background: Microscopic polyangiitis (MPA), a small-vessel antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, may present insidiously with prolonged fever, renal dysfunction, and pulmonary infiltrates--often mimicking infections, especially in tropical settings. Case presentation: A 61-year-old man with longstanding type 2 diabetes, hypertension, and a previous cerebrovascular accident presented with a 3-month history of low-grade fever, exertional dyspnea, fatigue, and pedal edema. He initially received meropenem for pan-resistant Klebsiella urinary infection; later received Helicobacter pylori therapy for gastritis. However, he remained febrile with rising creatinine. On admission, he was tachypneic, hypoxemic, and oliguric, with bilateral lung infiltrates, microscopic hematuria, and anemia (hemoglobin 5.5 g/dl). Infectious workup--including tropical fevers and tuberculosis--were negative. Perinuclear ANCA (P-ANCA) titre >200 U/ml, computerized tomography (CT) lung findings consistent with diffuse alveolar hemorrhage (DAH), and bronchoalveolar lavage positive for hemosiderin- laden macrophages established the diagnosis of MPA. Due to poor renal reserve, the biopsy was deferred. Treatment included intravenous pulse methylprednisolone (1 g/day x 3), three cycles of plasma exchange, and supportive low-efficiency dialysis. He improved clinically, was weaned off oxygen, and transitioned to oral steroids. Conclusion: This case illustrates the diagnostic challenge of MPA presenting as prolonged pyrexia of unknown origin (PUO) with pulmonaryrenal syndrome in a tropical context. After excluding infectious causes, early consideration of ANCA-associated vasculitis and prompt immunosuppressive therapy can be lifesaving. pubtype: Academic Journal doctype: case study diagnostic images tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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