A case report of antineutrophil cytoplasmic antibody-associated vasculitis and glomerular immune depositions.

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Hippokratia Pub Date : 2022-04-01

K Kaynar, B Güvercin, S Demir, S Mungan, E T Çifçi

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Abstract

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease leading to renal complications of pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN).

Case description: We present a 57-year-old female patient with rapidly progressive glomerulonephritis, multiple systemic infections [candidiasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], severe weight loss, arthralgia, positive myeloperoxidase ANCA, acute deterioration of cardiac function and NCGN with heavy deposition of immunoglobulin (Ig) A and complement 3 (C3) in kidney biopsy. After two months of follow-up and appropriate treatments [methylprednisolone (60 mg/day), cyclophosphamide (15 mg/kg)], our patient recovered from multiple life-threatening infections, including candidiasis treated by fluconazole and SARS-CoV-2 treated by methylprednisolone and acute cardiac failure. In addition, she was saved from dialysis despite all poor prognostic factors.

Conclusion: AAV might lead to immune complex deposition in kidneys due to different pathogenetic mechanisms like complement activation and immune complex formation, apart from losing tolerance to neutrophil proteins. HIPPOKRATIA 2022, 26 (2):86-88.

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抗中性粒细胞胞浆抗体相关血管炎和肾小球免疫沉积病例报告。

背景：抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）是一种系统性疾病，可导致缺乏免疫的局灶性和节段性坏死性新月体肾小球肾炎（PI-NCGN）的肾脏并发症，多发性全身感染[念珠菌感染和严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）]、严重体重减轻、关节痛、髓过氧化物酶ANCA阳性、心脏功能急性恶化和肾活检中免疫球蛋白（Ig）A和补体3（C3）大量沉积的NCGN。经过两个月的随访和适当的治疗[甲基强的松龙（60 mg/天）和环磷酰胺（15 mg/kg）]，我们的患者从多种危及生命的感染中康复，包括氟康唑治疗的念珠菌感染、甲基强的松治疗的严重急性呼吸系统综合征冠状病毒2型和急性心力衰竭。此外，尽管存在所有不良预后因素，她还是免于透析。结论：AAV除了对中性粒细胞蛋白失去耐受性外，还可能由于补体激活和免疫复合物形成等不同的发病机制导致免疫复合物在肾脏中沉积。海马2022，26（2）：86-88。

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来源期刊

Hippokratia MEDICINE, GENERAL & INTERNAL-

CiteScore

1.10

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hippokratia journal is a quarterly issued, open access, peer reviewed, general medical journal, published in Thessaloniki, Greece. It is a forum for all medical specialties. The journal is published continuously since 1997, its official language is English and all submitted manuscripts undergo peer review by two independent reviewers, assigned by the Editor (double blinded review process). Hippokratia journal is managed by its Editorial Board and has an International Advisory Committee and over 500 expert Reviewers covering all medical specialties and additionally Technical Reviewers, Statisticians, Image processing Experts and a journal Secretary. The Society “Friends of Hippokratia Journal” has the financial management of both the printed and electronic edition of the journal.