Microscopic Polyangiitis Presenting as Early Cardiac Tamponade

Kaur, Primal; Palya, Aniruddha; Hussain, Humaira; Dabral, S.

doi:10.1097/rhu.0b013e3181d06b55

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Symptoms that developed subsequently in this patient, such as cardiac tamponade and alveolar hemorrhage, indicate that the vasculitis was no longer limited to the kidneys, leading to a diagnosis of systemic vasculitis MPA. Her later symptoms were compatible with those of MPA as described in previous reports [2,25]. Other conditions that may cause MPA-like symptoms, such as malignancy, infection, medications, and other rheumatic or vasculitic diseases, were not observed.…”

Section: Discussionsupporting

confidence: 84%

Microscopic polyangiitis necrotizing glomerulonephritis associated with pregnancy: case with a 20-year clinical course and review of the literature

et al. 2018

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A 29-year-old woman with past medical history of hypertension was referred to our hospital for the evaluation of kidney dysfunction (serum creatinine 1.0 mg/dL), proteinuria (0.54 g/gCre), and microscopic hematuria. Renal biopsy before the first pregnancy was supportive for benign nephrosclerosis with no evidence of vasculitis. After her second pregnancy and delivery when she was 32 years old, she developed proteinuria of 3.2 g/gCre, hematuria, and elevated serum creatinine level of 2.6 mg/dL. Second renal biopsy revealed necrotizing glomerulonephritis and her serum MPO-ANCA was positive, leading to the diagnosis of MPA/renal-limited vasculitis (RLV). Interestingly, frozen preserved serum from 4 years earlier also tested positive for MPO-ANCA. Despite intensive treatment, hemodialysis was required 10 years later due to progressive deterioration of renal function. At that time, she developed pericarditis, bloody cardiac tamponade, and pulmonary alveolar hemorrhage, resulting in a diagnosis of systemic vasculitis MPA. She received living donor kidney transplantation at the age of 44 years, after which serum creatinine has been stable around 1.1 mg/dL without proteinuria or hematuria and MPO-ANCA has remained negative. The association of vasculitis with pregnancy and delivery is not well documented, especially in patients with MPA. Here, we report this MPO-ANCA positive woman developing MPA necrotizing glomerulonephritis after her second pregnancy and a 20-year clinical course.

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Section: Discussionsupporting

confidence: 84%

Microscopic polyangiitis necrotizing glomerulonephritis associated with pregnancy: case with a 20-year clinical course and review of the literature

et al. 2018

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“…These are uncommon manifestations of MPA. Two case reports of pericardial effusion in this context have been published [14,15] . Pleuritis and pleural effusion reflecting pulmonary involvement with MPA have been reported in 8–15% of affected individuals [16,17] .…”

Section: Discussionmentioning

confidence: 99%

Microscopic polyangiitis associated with pleuropericarditis, pulmonary embolism and pulmonary hemorrhage as a complication of silicosis

Al-Rajhi

Brega

Colman

2015

Respiratory Medicine Case Reports

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Silica (silicon dioxide) occupational exposure has been linked to both pulmonary and extra-pulmonary toxicity. Silicosis is the major pulmonary toxicity, which has also been associated with the development of collagen-vascular disease and with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis, especially perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA). The most common pulmonary manifestations of microscopic polyangitis (MPA) are interstitial fibrosis and alveolar hemorrhage. We describe a patient who had unusual presentation of microscopic polyangitis, characterized by lung hemorrhage, rapidly progressive glomerulonephritis, pleuropericarditis and pulmonary embolism that was associated with a history of silica exposure and radiologic evidence for silicosis.

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“…Aortos pažeidimas pasireiškia aneurizmos susiformavimu, neretai plyšimu ir mirtinomis klinikinėmis išeitimis dėl hemotorakso ar širdies tamponados susidarymo [13].…”

Section: Diskusijaunclassified

Mikroskopinis Poliangitas. Klinikinis Atvejis

Mažeikaitė

Kumžaitė

Povilenaite

2016

Medicinos Teorija Ir Praktika

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SANTRAUKAReikšminiai žodžiai: mikroskopinis poliangitas, ANCA, aortos aneurizma, širdies tamponada. Pristatome klinikinį atvejį 68 m. moters, kuri pirmą kartą kreipėsi į gydytojus 2003 m. dėl nepastovių, migruojančių sąnarių skausmų. 2008 m. dėl inkstų funkcijos sutrikimo atlikta biopsija, nustatytas židininis pusmėnulinis sklerozuojantis glomerulonefritas, asocijuotas su antineutrofilinių citoplazminių antikūnų (angl. antineutrophil cytoplasmic autoantibodies) buvimu. Diagnozuotas mikroskopinis poliangitas, paskirta prednizolono ir ciklofosfamido pulsterapija. Praėjus keturiems mėnesiams po prednizolono nutraukimo, atsirado plaštakų ir kelių sąnarių skausmai. Skirtas gydymas prednizolonu, azatioprinu, fosinopriliu (hipertenzijos korekcijai), vaistų dozės buvo koreguojamos atsižvelgiant į ligos eigą ir inkstų funkcijos rodiklius. 2014 m. diagnozuota antrinė sensomotorinė distalinė galūnių polineuropatija. 2015-05-10 pacientė kreipėsi dėl stiprių nugaros skausmų, kurie prasidėjo prieš 3 mėnesius. Įtarus aortos aneurizmą, atlikta krūtinės ląstos kompiuterinės tomografijos angiografija, nustatyta aortos kylančiosios dalies aneurizma be disekacijos požymių ir daugybiniai kompresiniai slankstelių lūžiai (krūtininiai 6-10, 12). Dėl sunkios būklės kardiochirurginė intervencija kontraindikuotina. 2015-05-11 diagnozuotas galvos smegenų infarktas, somnolencija, lengva tetraparezė. 2015-06-04 nustatyta kairės kojos ūminė giliųjų venų trombozė. 2015-06-23 plyšo kylančiosios aortos aneurizma, susidarė hemoperikardas ir išsivystė širdies tamponada, gaivinimo priemonės neefektyvios -konstatuota pacientės mirtis. Šiame straipsnyje pateikiame klinikinio atvejo analizę -pacientės, sergančios mikroskopiniu poliangitu, kuris pasireiškė sunkiomis ir retomis komplikacijomis. ABSTRACTKey words: microscopic polyangiitis, ANCA, aortic aneurysm, cardiac tamponade. We represent the clinical case of 68 years old woman, who appealed to the doctor in 2003 for the first time because of unstable, migratory achy joints. In 2008 biopsy was taken because of kidney failure symptoms, biopsy demonstrated focal sclerosing crescentic glomerulonephritis associated with the presence of anti-neutrophil cytoplasmic autoantibodies. Microscopic polyangiitis was diagnosed and prednizolon and cyclophosphamide pulse therapy were prescribed. Four months after prednizolon termination patient started to feel pain in joints of hands and knees. Applied treatment: prednizolon, azatioprin, fosinopril (for correction of hypertension). Doses were adjusted periodically according to the process of the disease and results of medical tests of kidney function. In 2014 secondary sensorimotor distal polyneuropathy of the limbs was diagnosed. Patient appealed on 10/05/2015 because of heavy back pain, which started 3 months ago. As the aortic aneurysm was suspected, chest Computed Tomography Angiography was made, which revealed ascending aortic aneurysm without signs of dissection and multiple compression fractures of vertebrae (thoracic 6-10, 12). Cardiac surgery was contraind...

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Microscopic Polyangiitis Presenting as Early Cardiac Tamponade

Cited by 6 publications

References 8 publications

Microscopic polyangiitis necrotizing glomerulonephritis associated with pregnancy: case with a 20-year clinical course and review of the literature

Microscopic polyangiitis necrotizing glomerulonephritis associated with pregnancy: case with a 20-year clinical course and review of the literature

Microscopic polyangiitis associated with pleuropericarditis, pulmonary embolism and pulmonary hemorrhage as a complication of silicosis

Mikroskopinis Poliangitas. Klinikinis Atvejis

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