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ISSN 1817-5996 (Electronic)

2020, Number S1

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Rev Cub de Reu 2020; 22 (S1)

Antineutrophil cytoplasmic antibody associated vasculitis: microscopic polyangiitis

Gálvez VJF, Martínez OJF, Vásquez BSP, Ortega AME

Language: Spanish
References: 15
Page:
PDF size: 405.39 Kb.


ABSTRACT

Microscopic Polyangiitis is defined as an autoimmune, multisystemic, low prevalence disease, associated to antineutrophil cytoplasmic antibody. Characterized by necrotizing vasculitis of small vessels, with no granulomatous inflammation and absence of immune complex deposits, predominantly affecting renal, pulmonary and cutaneous tissue. 49-year old male patient with no past medical history. Refers symptomatology that started thirty days ago, characterized by dry cough, that evolves to productive cough, hemoptysis, exertional dyspnea, asthenia and pitting edema. Laboratory tests show severe anemia, glomerular filtration rate of 6.9 ml/min/1.73m2, hematuria, proteinuria, positive presence of antineutrophil cytoplasmic antibodies and anti-myeloperoxidase antibodies, additional thoracic imaging shows ground glass opacities consolidations. Immunosuppressive therapy is started with Methylprednisolone and Cyclophosphamide along with antibiotic prophylaxis, resulting in a decrease in the vasculitis activity score with subsequent remission; however due to renal tissue damage, there is no improvement in the glomerular filtration rate and the patient continues receiving renal replacement therapy. Due to its striking morbidity and mortality, we consider of great importance the knowledge of its clinical presentation, diagnostic procedures and treatment, in order to obtain a positive impact on the patient’s quality of life and survival rate.


REFERENCES

  1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan [Access 05/01/2020];65(1):1-11. Available from: http://doi.wiley.com/10.1002/art.37715

  2. Pierini FS, Scolnik M, Scaglioni V, Mollerach F, Soriano ER. Incidence and prevalence of granulomatosis with polyangiitis and microscopic polyangiitis in health management organization in Argentina: a 15-year study. Clin Rheumatol. 2019 Jul 11 [Access 05/01/2020];38(7):1935-40. Available from: http://link.springer.com/10.1007/s10067-019-04463-y

  3. Wójcik K, Wawrzycka-Adamczyk K, Wludarczyk A, Sznajd J, Zdrojewski Z, Masiak A, et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides -retrospective analysis of POLVAS registry. Clin Rheumatol. 2019 Apr 23 [Access 05/01/2020]. Available from: http://link.springer.com/10.1007/s10067-019-04538-w

  4. Hutton HL, Holdsworth SR, Kitching AR. ANCA-Associated Vasculitis: Pathogenesis, Models, and Preclinical Testing. Semin Nephrol. 2017 Sep [Access 05/01/2020];37(5):418-35. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0270929517300554

  5. Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. 2016 Sep;75(9):1583-94. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2016-209133

  6. Correia SI, Eira I, Santa Cruz A, Ângela C. Pulmonary-renal syndrome: diagnostic challenge. BMJ Case Rep. 2019 Apr 25;12(4):e227720. Available from: http://casereports.bmj.com/lookup/doi/10.1136/bcr-2018-227720

  7. Schirmer JH, Wright MN, Vonthein R, Herrmann K, Nölle B, Both M, et al. Clinical presentation and long-term outcome of 144 patients with microscopic polyangiitis in a monocentric German cohort. Rheumatology. 2016 Jan;55(1):71-9. Available from: https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/kev286

  8. Bezerra AS, Polimanti AC, Fürst RV de C, Corrêa JA. Algorithm for diagnosis of primary vasculitides. J Vasc Bras. 2019 Mar 28 [Access 05/01/2020];18. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492019000100404&lng=en&tlng=en

  9. Pagnoux C. Updates in ANCA-associated vasculitis. Eur J Rheumatol. 2016 Sep 26 [Access 05/01/2020];3(3):122-33. Available from: http://www.eurjrheumatol.org/sayilar/207/buyuk/122-133.pdf

  10. de Groot K. Pulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic Antibody -Associated Vasculitis. Ann Intern Med. 2009 May 19 [Access 05/01/2020];150(10):670. Available from: http://annals.org/article.aspx?doi=10.7326/0003-4819-150-10-200905190-00004

  11. Harper L, Morgan MD, Walsh M, Hoglund P, Westman K, Flossmann O, et al. Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis. 2012 Jun;71(6):955-60. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2011-200477

  12. Córdoba JP, González C, Huérfano M, Vela F, Rodríguez P. Síndrome pulmón-riñón: serie de casos del Hospital Universitario San Ignacio. Rev Colomb Reumatol. 2015 Mar [Access 05/01/2020];22(1):11-5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0121812315000109

  13. Espígol-Frigolé G, Prieto-González S, Hernández-Rodríguez J, Cid Xutglá MC. Protocolo diagnóstico de las vasculitis sistémicas. Med Programa Form Médica Contin Acreditado. 2017 Apr [Access 05/01/2020];12(29):1739-43. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0304541217300641

  14. Ronald JFM. Clinical Spectrum of antineutrophil cytoplasmic autoantibodies. Post TW, ed. Up to Date Waltham, MA Up to Date INC. 2019 [Access 18/07/2019]. Available from: https://www.uptodate.com/contents/clinical-spectrum-of-antineutrophil-cytoplasmic-autoantibodies

  15. Sushrut S. Lesión renal aguda. In: Longo D, Kasper D, Jameson J, Fauci A, Hauser SLJ, ed. Principios de Medicina Interna de Harrison. 19th ed. Mc Graw Hill; 2015. p. 1808.




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