Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis with a unique imaging presentation of organizing pneumonia: A case report. (2020)

• Record Type: Journal Article
• Authors: Takada, Kazufumi; Miyamoto, Atsushi; Nakahama, Hiroshi; Moriguchi, Shuhei; Takahashi, Yui; Ogawa, Kazumasa; Murase, Kyoko; Hanada, Shigeo; Morokawa, Nasa; Kurosaki, Atsuko; Fujii, Takeshi; Hasegawa, Eiko; Takaya, Hisashi; Takai, Daiya
• Is Part Of: Respiratory medicine case reports. Volume 31(2020)
• Publication Date: 2020
• Subjects: Organizing pneumonia -- MPO-ANCA -- ANCA associated Vasculitis; AAV anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis -- ANCA anti-neutrophil cytoplasmic antibody -- BMI body mass index -- CRP C-reactive protein -- CT computed tomography -- EGPA eosinophilic granulomatosis with polyangiitis -- GPA granulomatosis with polyangiitis -- IP interstitial pneumonia -- MPA microscopic polyangiitis -- MPO myeloperoxidase -- UIP usual interstitial pneumonia; Respiratory organs -- Diseases -- Periodicals; Chest -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System -- Periodicals; Chest -- Diseases; Respiratory organs -- Diseases; Electronic journals; Periodicals; 616.2
• DOI: 10.1016/j.rmcr.2020.101294
• Languages: English
• ISSNs: 2213-0071

Abstract

Abstract: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of blood vessel inflammation diseases of autoimmune origin. Myeloperoxidase (MPO) ANCA is closely related to ANCA associated AAV. The MPO-ANCA positive AAV patients have lung involvement at high rates; however, there are only a few reported cases with organizing pneumonia (OP). A 78-year-old man was presented to our hospital due to a fever of 38 °C despite a whole month of antibiotics treatment. Chest computed tomography image revealed restricted consolidations visible in the middle lobe of the right lung and the upper lobe of the left lung, which suggested an OP pattern. MPO-ANCA and urine occult blood tests were positive. Histopathological examination of the transbronchial biopsy revealed OP and mucus plug. Histological findings on renal biopsy showed necrotizing glomerulonephritis related to AAV. The patient was diagnosed with MPO-ANCA positive AAV and was treated with systemic corticosteroid therapy, from which he recovered rapidly. Thus, when diagnosing OP, the possibility of AAV should be considered by ordering patients' serum ANCA and occult hematuria tests.