scholarly journals Antineutrophil cytoplasmic antibody-associated vasculitis with alveolar hemorrhage and ruptured renal aneurysm

Medicine ◽  
2022 ◽  
Vol 101 (1) ◽  
pp. e28543
Author(s):  
Jin Tong ◽  
Zhi-Yu Zhou ◽  
Xi Liu ◽  
Dao-Xin Wang ◽  
Wang Deng
2021 ◽  
Author(s):  
Wang Deng ◽  
Zhi-Yu Zhou ◽  
Xi Liu ◽  
Xiao-Qing Luo ◽  
Jin Tong ◽  
...  

Abstract Background: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is characterized by necrotizing damage of small -vessel vasculitis and the main violation of the kidney or lung. Manifestation of alveolar hemorrhage and renal aneurysm is extremely rare in Granulomatosis with polyangiitis (GPA).Case presentation: A 50-year-old Chinese man was admitted due to repeated cough, expectoration, fever and shortness of breath. A chest computed tomography (CT) scan showed bilateral infiltrates in the lower lobe of the lung. GPA was considered based on the pulmonary capillaritis, alveolar hemorrhage, renal insufficiency and cANCA -PR3 positivity. Immunosuppressive therapy combined with plasma exchange (PE) was performed. The patient suffered from a rupture of renal aneurysm. Though selective renal arterial embolization was performed, the patient had a poor outcome. Conclusions: GPA could be life-threatening, especially large vessel vasculitis involved. The possibility of aneurysmal rupture should be carefully considered and checked frequently in the condition of immunosuppressive therapy.


2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Kenichi Nitta ◽  
Hiroshi Imamura ◽  
Akihiro Yashio ◽  
Satoko Kashima ◽  
Katsunori Mochizuki

Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures. On day 8, she developed deep venous thrombosis, and edoxaban was administered orally. On day 38, she developed fungemia, which was treated with an antifungal drug. On day 43, she presented with dyspnea. Chest computed tomography scan showed bilateral diffuse ground-glass opacities in the whole lung fields. The results of the subsequent workup (i.e., serum levels of the antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane antibody) and microbiological study were unremarkable. Based on these findings, her condition was diagnosed as diffuse alveolar hemorrhage (DAH) associated with edoxaban therapy. The lung opacities disappeared spontaneously after edoxaban therapy was discontinued. Conclusion. DAH is a dangerous complication associated with edoxaban therapy. DOACs, including edoxaban, should be prescribed with caution, especially for patients in a critical condition.


2021 ◽  
Vol 84 (4) ◽  
pp. 255-262
Author(s):  
Min Jung Kim ◽  
Kichul Shin

Microscopic polyangiitis (MPA) is an antineutrophil cytoplasmic antibody (ANCA)‒associated necrotizing vasculitis, which mainly affects small vessels in various organs, especially the lungs. The two key pulmonary manifestations, interstitial lung disease (ILD) and diffuse alveolar hemorrhage (DAH), increase the morbidity and death rate of patients with MPA. ILD is more common in MPA than in other ANCA-associated vasculitis subsets and is primarily associated with myeloperoxidase-ANCA. Unlike alveolar hemorrhage due to pulmonary capillaritis, ILD can initially manifest as isolated pulmonary fibrosis. Of note, its most frequent radiographic pattern is the usual interstitial pneumonia pattern, similar to the characteristic pattern seen in idiopathic pulmonary fibrosis. In this review we present the pathogenesis, clinical manifestations, and radiographic and histopathologic features of ILD and DAH in MPA. We also briefly summarize the outcome and therapeutic options for the two conditions.


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