A Case Report Describing a Rare Presentation of Simultaneous Occurrence of MPO-ANCA-Associated Vasculitis and Rheumatoid ArthritisReportar como inadecuado




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Case Reports in Nephrology - Volume 2016 2016, Article ID 9340524, 5 pages -

Case Report

Department of Internal Medicine, Southern Illinois University, 751 North Rutledge, Springfield, IL 62702, USA

Department of Pathology, Memorial Medical Center, 701 North 1st Street, Springfield, IL 62781, USA

Received 24 July 2016; Revised 27 September 2016; Accepted 16 October 2016

Academic Editor: Kouichi Hirayama

Copyright © 2016 Nathalie Foray et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Renal-limited myeloperoxidase vasculitis with simultaneous rheumatoid arthritis is reported as a rare occurrence. Review of literature suggests that most patients had a diagnosis of rheumatoid arthritis for several years prior to presenting with renal failure from myeloperoxidase vasculitis. Case Presentation. A 58-year-old Caucasian male presented to the hospital experiencing malaise, fevers, decreased oral intake, nausea, and vomiting for one week duration. His past medical history consisted of newly diagnosed but untreated rheumatoid arthritis, hypertension, and non-insulin-dependent diabetes mellitus. He was found to have acute renal failure, proteinuria, and hypoglycemia. Standard therapy, including intravenous fluids, did not improve his acute renal failure. A vasculitis workup resulted in a positive myeloperoxidase anti-neutrophil cytoplasmic antibody MPO-ANCA. Renal biopsy revealed crescentic glomerulonephritis GN pauci-immune type, suggestive of MPO-ANCA-associated vasculitis MPO-AAV. Treatment consisted of prednisone, cyclophosphamide, and seven cycles of plasmapheresis, in addition to hemodialysis for uremia. Upon discharge, he received hemodialysis for another week and continued treatment with cyclophosphamide and prednisone. Conclusion. Patients with longstanding rheumatoid arthritis may develop renal failure due to nonsteroidal anti-inflammatory medication use and AA type amyloidosis; however, necrotizing glomerulonephritis with crescent formation has been rarely reported. This stresses the importance of early recognition and swift initiation of treatment.





Autor: Nathalie Foray, Tamer Hudali, Muralidhar Papireddy, and John Gao

Fuente: https://www.hindawi.com/



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