Microscopic polyangiitis presented with polyneuropathy of lower extremities and ANCA-associated glomerulonephritis: Case Report

Abstract

We present the case of a 67-year-old female patient with microscopic polyangiitis presented with polyneuropathy of lower extremities and rapidly progressive glomerulonephritis. Disease had started as a pain and weakening of muscular strength first in the left and than in the right leg. Electromiography has shown that a mainly dominant neurological affection was paresis of peroneal nerve in both lower extremities. In laboratory examination the titer of anti-myeloperoxidase anti-neutrophilic cytoplasmic antibodies (p-ANCA) was elevated. Due to renal involvement presented as a microscopic haematuria and decreasing of renal function, patient undergone kidney biopsy. It confirmed the immune vasculitis microscopic polyangiitis type with ANCA-associated glomerulonephritis. This is one of rare case of microscopic polyangiitis without lung simptomatology, first presented with asymmetrical polineuropathy of lower extremities. The patient was treated with methylprednisolone and cyclophosphamide in dosis adjusted to the level of disease severity and the renal function (methylprednisolone 1 mg/kg of body weight for two months with gradually tapering to the minimum effective dose and cyclophosphamide 1 mg/kg of body weight). This treatment lead to the partial remission of disease. In maintenance therapy azathioprin was introduced instead of cyclophosphamide.

Microscopic Polyangiitis Presenting with Acute Abdominal Pain Due to Rare Small Intestine Involvement

“…Given the severity of the condition, delaying treatment for a tissue diagnosis is often not feasible. [3][4][5] Therefore, in complex cases like our patient, it is imperative to swiftly consider differential diagnoses and commence appropriate immunosuppressive treatment.…”

Mikroskopinis Poliangitas. Klinikinis Atvejis

“…antineutrophil cytoplasmic autoantibodies -ANCA) buvimu. MPA dažnai manifestuoja greitai progresuojančiu glomerulonefritu [1,2] arba plaučių pažeidimu [2]. Pagal 2012 m. peržiūrėtą Chapel Hill konferencijos nomenklatūrą MPA, granulomatozė su poliangitu (Wegener's granulomatozė) ir eozinofilinė granulomatozė su poliangitu (Churgo-Strausso sindromas) yra priskiriami ANCA asocijuotų vaskulitų grupei [3].…”

“…Atlikus inkstų biopsiją, nustatytas ANCA asocijuotas glomerulonefritas, skirtas gydymas imunosupresantais (ciklofosfamido ir prednizolono pulsterapija), inkstų funkcija atsistatė. Inkstų pažeidimas yra ankstyvas MPA klinikinis simptomas, dažnai prasideda greitai progresuojančiu glomerulonefritu [1,2].…”