A case of microscopic polyangiitis in an elderly patient presenting predominantly with cholecystitis successfully treated with mizoribine

Abstract

An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 lg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.

Hemocholecyst complicated in a hemodialysis patient with microscopic polyangiitis

“…MPA is a systemic vasculitis associated with ANCA, which mainly affects the kidneys and lungs. Gastrointestinal involvement occurs in various vasculitides; however, gallbladder involvement such as cholecystitis rarely reported in patients with MPA [1][2][3]. One possible explanation why the gallbladder is damaged by vasculitides including MPA is that the gallbladder differs in the lack of muscular layer of mucosa and submucosal layer from other gastrointestinal tracts, which means inflammation of blood vessel walls could spread in the gallbladder.…”

“…Microscopic polyangiitis (MPA) is a systemic vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). Although the commonly affected organs include the kidneys and lungs, the involvement of the gallbladder (i.e., cholecystitis) rarely occurs in patients with MPA [1][2][3]. However, to our knowledge, this is the first case report of patients with MPA who developed hemocholecyst.…”

Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen?

“…After identifying 671 articles, 153 articles involving 171 cases were eligible: 104 viral infection and 67 rheumatic disease AAC patients. [8,11–162] Viral infection types included: Epstein Barr virus, hepatitis virus, dengue virus, SARS-CoV-2 (COVID-19), human immunodeficiency virus, and cytomegalovirus. Rheumatic diseases included: systemic lupus erythematosus, adult-onset Still disease, Henoch-Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), microscopic polyangiitis, temporal arteritis, Wegener granulomatosis (granulomatosis with polyangiitis), Kawasaki syndrome, systemic juvenile idiopathic arthritis, and juvenile dermatomyositis (Table 1).…”

Onset of Takotsubo Syndrome during the Clinical Course of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report

“…Purpura and arthritis are also developed (Puéchal 2007). Furthermore, cholecystitis, gallbladder hemorrhage, hypertrophic pachymeningitis, and cerebral bleeding including subarachnoid hemorrhage have been reported as rare complications of AAV (Puéchal 2007;Ichinose et al 2014;Decker et al 2016;Kitaguchi et al 2017). Coronary arteritis, pericarditis, and arrhythmia have been reported previously as the main cardiac complications in patients with AAV (Miloslavsky and Unizony 2014).…”