Successful Treatment of Dual-Positive Anti-Myeloperoxidase and Anti-Glomerular Basement Membrane Antibody Vasculitis with Pulmonary-Renal Syndrome

Overview

Journal Case Rep Nephrol Dial

Specialty Nephrology

Date 2016 Feb 19

PMID 26889474

Citations 2

Authors

Jinxian Huang

Ling Wu

Xiaoyan Huang

Yan Xie

Jinquan Yu

Jin Yang

Huiqiong Fang

Lijun Zhang

Affiliations

Soon will be listed here.

Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and anti-glomerular basement membrane (GBM) disease are two separate diseases, while sometimes they can coexist together. The exact mechanisms are not clear, but due to the rapid progression and poor prognosis, prompt and aggressive treatment is usually required. We treated with steroids combined with cyclophosphamide and rituximab an 84-year-old man with ANCA-associated vasculitis and anti-GBM disease who had prior pulmonary fibrosis and a coexisting anterosuperior mediastinal mass. Conventional therapy including steroids, plasmapheresis and cyclophosphamide failed to attenuate the anti-GBM disease, yet he responded to an alternative treatment of rituximab. This case suggests the efficacy of steroids and immunosuppressant for the treatment of a dual-positive case with an anterosuperior mediastinal mass.

Citing Articles

Two Decades Rituximab Therapy in Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis.

Habibi M, Ahmadpour S, Tafaroji J, Eazi S, Mineaie P, Minaee P Curr Drug Targets. 2024; 26(2):73-87.

PMID: 39318005 DOI: 10.2174/0113894501323529240910015912.

The Immunobiological Agents for Treatment of Antiglomerular Basement Membrane Disease.

Yamashita M, Takayasu M, Maruyama H, Hirayama K Medicina (Kaunas). 2023; 59(11).

PMID: 38004064 PMC: 10673378. DOI: 10.3390/medicina59112014.

Pulmonary-renal syndrome: diagnostic challenge.

Correia S, Eira I, Santa Cruz A, Angela C BMJ Case Rep. 2019; 12(4).

PMID: 31028048 PMC: 6506138. DOI: 10.1136/bcr-2018-227720.

References

Bal A, Das A, Gupta D, Garg M . Goodpasture's Syndrome and p-ANCA Associated Vasculitis in a Patient of Silicosiderosis: An Unusual Association. Case Rep Pulmonol. 2014; 2014:398238. PMC: 4202243. DOI: 10.1155/2014/398238. View

Homma S, Matsushita H, Nakata K . Pulmonary fibrosis in myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitides. Respirology. 2004; 9(2):190-6. DOI: 10.1111/j.1440-1843.2004.00581.x. View

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

Sinclair D, Stevens J . Role of antineutrophil cytoplasmic antibodies and glomerular basement membrane antibodies in the diagnosis and monitoring of systemic vasculitides. Ann Clin Biochem. 2007; 44(Pt 5):432-42. DOI: 10.1258/000456307781646049. View

Linkins L, Warkentin T, Pai M, Shivakumar S, Manji R, Wells P . Design of the rivaroxaban for heparin-induced thrombocytopenia study. J Thromb Thrombolysis. 2014; 38(4):485-92. DOI: 10.1007/s11239-014-1064-7. View

Yamazaki K, Kanehira K, Inaba Y, Shimizu J, Sugiyama N . [A case of rapidly progressive glomerulonephritis with anti-glomerular basement membrane antibody in the course of MPO-ANCA positive interstitial pneumonia]. Nihon Jinzo Gakkai Shi. 2013; 54(8):1203-8. View

Ng H, Than H, Teo E . First experiences with the use of rivaroxaban in the treatment of heparin-induced thrombocytopenia. Thromb Res. 2014; 135(1):205-7. DOI: 10.1016/j.thromres.2014.06.005. View

Emmi G, Silvestri E, Squatrito D, Amedei A, Niccolai E, DElios M . Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J. 2015; 13:15. PMC: 4399148. DOI: 10.1186/s12959-015-0047-z. View

Kobayashi M, Saito M, Minoshima S, Arimura Y, Nagasawa T . [A case of progressive systemic sclerosis with crescentic glomerulonephritis associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) and anti-glomerular basement membrane antibody (anti-GBM Ab)]. Nihon Jinzo Gakkai Shi. 1995; 37(3):207-11. View

10.

McGregor J, Hogan S, Kotzen E, Poulton C, Hu Y, Negrete-Lopez R . Rituximab as an immunosuppressant in antineutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant. 2015; 30 Suppl 1:i123-31. PMC: 4447867. DOI: 10.1093/ndt/gfv076. View

11.

Parambil J, Keogh K, Fervenza F, Ryu J . Microscopic polyangiitis associated with thymoma, exacerbating after thymectomy. Am J Kidney Dis. 2006; 48(5):827-31. DOI: 10.1053/j.ajkd.2006.07.020. View

12.

Arzoo K, Sadeghi S, Liebman H . Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab). Ann Rheum Dis. 2002; 61(10):922-4. PMC: 1753910. DOI: 10.1136/ard.61.10.922. View

13.

Miyares M, Davis K . Direct-acting oral anticoagulants as emerging treatment options for heparin-induced thrombocytopenia. Ann Pharmacother. 2015; 49(6):735-9. DOI: 10.1177/1060028015579424. View

14.

Hantson P, Lambert C, Hermans C . Rivaroxaban for arterial thrombosis related to heparin-induced thrombocytopenia. Blood Coagul Fibrinolysis. 2014; 26(2):205-6. DOI: 10.1097/MBC.0000000000000205. View

15.

Comarmond C, Crestani B, Tazi A, Hervier B, Adam-Marchand S, Nunes H . Pulmonary fibrosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis: a series of 49 patients and review of the literature. Medicine (Baltimore). 2014; 93(24):340-349. PMC: 4602438. DOI: 10.1097/MD.0000000000000217. View