The development of rapidly progressive glomerulonephritis associated with both antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane nephritis in the course of nontuberculous mycobacterium infection: a case report

Abstract

Background Antineutrophil cytoplasmic antibodies (ANCA) and Anti-glomerular basement membrane (GBM) antibodies often induce rapidly progressive glomerulonephritis (RPGN). Some reports have demonstrated RPGN with the sequential appearance of ANCA then anti-GBM antibodies, suggesting that ANCA may induce the development of anti-GBM antibodies. Whereas, many reports have shown that the development of ANCA is associated with various infectious diseases, such as non-tuberculous mycobacterial infection. Case presentation A 65-year-old woman with pulmonary non-tuberculous mycobacterial (NTM) infection was monitored without treatment. One year later, serum myeloperoxidase (MPO)- ANCA were elevated (14.1 U/mL (normal value < 3.0 U/ml)). A high fever and RPGN appeared 1 year later, and serum MPO-ANCAs were 94.1 U/mL. Anti-GBM antibodies were also detected. A renal biopsy revealed crescentic glomerulonephritis with linear deposits of IgG and C3c along the GBM and interstitial inflammation with endarteritis of arterioles. The diagnosis was RPGN associated with anti-GBM nephritis and ANCA-associated vasculitis. Conclusion This report shows that preceding NTM infection may have induced ANCA and anti-GBM antibodies and caused the development of RPGN.

A case report of atypical antiglomerular basement membrane nephritis associated with Mycobacterium Avium

“…Rapidly progressive glomerulonephritis related to NTM is very rare. We were only able to retrieve two prior case reports of rapidly progressive glomerulonephritis in relation to NTM – one with ANCA-associated vasculitis [ 3 ] and one with double-positive ANCA and anti-GBM [ 4 ] disease. To the best of our knowledge, this is the first case report of atypical anti-GBM nephritis associated with NTM.…”

A Case of Eosinophilic Granulomatosis with Polyangiitis Combined with Pulmonary Tuberculosis: A Case Report

“…On the other hand, studies reports suggest that the development of ANCA is associated with Mycobacterium tuberculosis infection. One case report found that a patient with non-tuberculosis Mycobacterium infection developed ANCAassociated vasculitis after one year [14] . The studies indicated that NTM infection may induce ANCA.…”

Triple Jeopardy: Rapidly Progressive Glomerulonephritis Induced by Triple Seropositive Disease—A Rare Case

“…Double antibody-positive disease (DAPD), exhibiting antiglomerular basement (anti-GBM) and antineutrophil cytoplasmic antibodies (ANCAs) are auto-antibody mediated small vessel vasculitis with ideal preference to renal and pulmonary systems [ 5 ]. Several factors such as smoking, viral infection, or hydrocarbon compounds could precipitate this disease [ 5 , 6 ]. It is a variant of Goodpasture syndrome (GPS).…”

“…Anti-GBM disease is characterized by an autoimmune response against the α 3 chain of type IV collagen on the GBM in GPS [ 7 ]. Contrastingly, myeloperoxidase (MPO) and proteinase 3 (PR3) antibodies are features of ANCA-associated vasculitis (granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis) [ 5 ]. ANCA-associated vasculitis (AAV) can include the following features: purpura (granulomatous and nongranulomatous skin lesions), neuropathy, acute renal failure (due to neutrophil infiltration into renal tissue), hemoptysis (due to alveolar hemorrhage and nasopharyngeal/oropharyngeal tract hemorrhage), as well as more nonspecific features, such as arthralgias and fatigue.…”

“…ANCA-associated vasculitis (AAV) can include the following features: purpura (granulomatous and nongranulomatous skin lesions), neuropathy, acute renal failure (due to neutrophil infiltration into renal tissue), hemoptysis (due to alveolar hemorrhage and nasopharyngeal/oropharyngeal tract hemorrhage), as well as more nonspecific features, such as arthralgias and fatigue. Rapidly progressive glomerulonephritis with or without pulmonary involvement is an independent feature of either anti-GBM or ANCAs, making DAPD patients at risk of worsening renal outcomes [ 5 , 7 , 8 ].…”