A Rare Case of Anti Neutrophil Cytoplasmic Antibody Associated Vasculitis Presenting as Pyelonephritis
Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) is a condition affecting small and medium-sized vessels, predominantly impacting the kidneys. Microscopic Polyangiitis (MPO) is primarily associated with antibodies to myeloperoxidase. MPO frequently presents as glomerulonephrit...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-05-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/20938/78805_CE[Ra1]_F(IS)_QC_PF1(HJ_IS)_PFA_NC(IS)_PN(IS).pdf |
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| Summary: | Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) is a condition affecting small and medium-sized vessels, predominantly impacting the kidneys. Microscopic Polyangiitis (MPO) is primarily associated with antibodies to myeloperoxidase. MPO frequently presents as glomerulonephritis, but pyelonephritis has not been mentioned hitherto in the literature as an initial presentation. Granulomatosis with Polyangiitis (GPA) is known to present as pyelonephritis, but not MPO. Such an unusual presentation may masquerade as an infectious condition when the underlying cause may, in fact, be an autoimmune one. This case report concerns a patient who presented with pyelonephritis. The patient also exhibited lung involvement that appeared to be pneumonia. Sepsis was suspected initially, and antibiotics were commenced. He also experienced renal failure and required haemodialysis. As the condition did not resolve, extensive investigations were conducted. An autoimmune panel and a renal biopsy revealed AAV as the underlying condition. Prompt treatment with glucocorticoids and rituximab resulted in a dramatic improvement in the patient’s condition. The patient did not require further haemodialysis, and he subsequently recovered and was discharged. The patient is on regular follow-up and requires only a small maintenance dose of prednisone. This case report demonstrates that pyelonephritis may not always have an infection as its underlying cause. A high index of suspicion for an autoimmune cause may result in early treatment and can be life-saving. |
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| ISSN: | 2249-782X 0973-709X |