Dual Anti-Glomerular Basement Membrane and Anti-Neutrophil Cytoplasmic Antibodies-Positive Rapidly Progressive Glomerulonephritis with Rheumatoid Arthritis and Sjogren's Syndrome: A Case Report and Literature Review

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Nov 26

PMID 36431270

Authors

Ting Cheng

Huiwen Zhi

Yunxiao Liu

Shengxiao Zhang

Ziyi Song

Yafeng Li

Affiliations

Soon will be listed here.

Abstract

Rapidly progressive glomerulonephritis (RPGN) is a life-threatening disease characterized by rapid progressive deterioration of renal function and extensive formation of crescents. Some antibodies tend to be positive, such as a perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) and anti-glomerular basement membrane (anti-GBM) antibodies, in most patients with the disease. However, cases of double positivity for the above antibodies are considered to be rare. In addition, both rheumatoid arthritis (RA) and Sjogren's syndrome (SS) are deemed to be independent immune disorders that can cause renal impairment. Nevertheless, the association between RPGN and these two diseases has not been elucidated in previous studies. Here, we provide a case of RPGN with the concurrence of RA and SS characterized by double positivity in anti-GBM antibodies and p-ANCA. After aggressive treatment with cyclophosphamide, glucocorticoids, and plasma exchange, the patient improved significantly. Despite the malignant event of arteriovenous fistula rupture and bleeding during treatment, the patient survived with renal function recovery for the rest of the follow-up period.

References

Rutgers A, Slot M, van Paassen P, van Breda Vriesman P, Heeringa P, Cohen Tervaert J . Coexistence of anti-glomerular basement membrane antibodies and myeloperoxidase-ANCAs in crescentic glomerulonephritis. Am J Kidney Dis. 2005; 46(2):253-62. DOI: 10.1053/j.ajkd.2005.05.003. View

Guellec D, Cornec-Le Gall E, Groh M, Hachulla E, Karras A, Charles P . ANCA-associated vasculitis in patients with primary Sjögren's syndrome: detailed analysis of 7 new cases and systematic literature review. Autoimmun Rev. 2015; 14(8):742-50. DOI: 10.1016/j.autrev.2015.04.009. View

McAdoo S, Tanna A, Hruskova Z, Holm L, Weiner M, Arulkumaran N . Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients. Kidney Int. 2017; 92(3):693-702. PMC: 5567410. DOI: 10.1016/j.kint.2017.03.014. View

Sebastiani M, Luppi F, Sambataro G, Castillo Villegas D, Cerri S, Tomietto P . Interstitial Lung Disease and Anti-Myeloperoxidase Antibodies: Not a Simple Association. J Clin Med. 2021; 10(12). PMC: 8227546. DOI: 10.3390/jcm10122548. View

Icardi A, Araghi P, Ciabattoni M, Romano U, Lazzarini P, Bianchi G . [Kidney involvement in rheumatoid arthritis]. Reumatismo. 2003; 55(2):76-85. DOI: 10.4081/reumatismo.2003.76. View

ODonoghue D, Short C, Brenchley P, Lawler W, Ballardie F . Sequential development of systemic vasculitis with anti-neutrophil cytoplasmic antibodies complicating anti-glomerular basement membrane disease. Clin Nephrol. 1989; 32(6):251-5. View

Kurita N, Mise N, Fujii A, Mori M, Sai K, Nishi T . Myeloperoxidase-antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with rheumatoid arthritis: a comparison of patients without rheumatoid arthritis. Clin Exp Nephrol. 2010; 14(4):325-32. DOI: 10.1007/s10157-010-0278-z. View

Zhao J, Yang R, Cui Z, Chen M, Zhao M, Wang H . Characteristics and outcome of Chinese patients with both antineutrophil cytoplasmic antibody and antiglomerular basement membrane antibodies. Nephron Clin Pract. 2007; 107(2):c56-62. DOI: 10.1159/000107803. View

Lee S, Choi H, Kim M, Jung S, Song J, Park Y . Can antineutrophil cytoplasmic antibody positivity at diagnosis predict the poor outcomes of Sjögren's syndrome?. Rheumatol Int. 2019; 40(7):1063-1070. DOI: 10.1007/s00296-019-04476-5. View

10.

Francois H, Mariette X . [Renal involvement in Sjögren's syndrome]. Nephrol Ther. 2020; 16(7):440-452. DOI: 10.1016/j.nephro.2020.10.002. View

11.

Wang W, Wu H, Chu T . Anti-neutrophil cytoplasmic antibody-associated Pauci-immune crescentic glomerulonephritis complicating Sjögren's syndrome. J Formos Med Assoc. 2011; 110(7):473-7. DOI: 10.1016/S0929-6646(11)60070-3. View

12.

Mustila A, Paimela L, Leirisalo-Repo M, Huhtala H, Miettinen A . Antineutrophil cytoplasmic antibodies in patients with early rheumatoid arthritis: an early marker of progressive erosive disease. Arthritis Rheum. 2000; 43(6):1371-7. DOI: 10.1002/1529-0131(200006)43:6<1371::AID-ANR22>3.0.CO;2-R. View

13.

Ramos-Casals M, Nardi N, Brito-Zeron P, Aguilo S, Gil V, Delgado G . Atypical autoantibodies in patients with primary Sjögren syndrome: clinical characteristics and follow-up of 82 cases. Semin Arthritis Rheum. 2006; 35(5):312-21. DOI: 10.1016/j.semarthrit.2005.12.004. View

14.

Draibe J, Salama A . Association of ANCA associated vasculitis and rheumatoid arthritis: a lesser recognized overlap syndrome. Springerplus. 2015; 4:50. PMC: 4315802. DOI: 10.1186/s40064-015-0835-8. View

15.

Mustila A, Korpela M, Mustonen J, Helin H, Huhtala H, Soppi E . Perinuclear antineutrophil cytoplasmic antibody in rheumatoid arthritis: a marker of severe disease with associated nephropathy. Arthritis Rheum. 1997; 40(4):710-7. DOI: 10.1002/art.1780400417. View

16.

Balderia P, Andeen N, Jefferson J . Characteristics and Outcomes of Patients with Anti-Glomerular Basement Membrane Antibody Disease and Anti-Neutrophil Cytoplasmic Antibodies. Curr Rheumatol Rev. 2018; 15(3):224-228. DOI: 10.2174/1573397114666180516131240. View

17.

Spoerl D, Pers Y, Jorgensen C . Anti-neutrophil cytoplasmic antibodies in rheumatoid arthritis: two case reports and review of literature. Allergy Asthma Clin Immunol. 2012; 8(1):19. PMC: 3552688. DOI: 10.1186/1710-1492-8-19. View