ANCA negative pulmonary vasculitis: a challenging diagnosis.
Zhang, Yimeng Mayor, Kara Mahdi, Amar
Zhang, Yimeng
Mayor, Kara
Mahdi, Amar
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2024-06-19
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Abstract
A man in his 40s with end-stage kidney disease due to IgA nephropathy and receiving peritoneal dialysis presented with a 1-week history of breathlessness, cough and nosebleeds. CT scan of the chest revealed ground glass changes while blood tests indicated elevated inflammatory markers and a negative vasculitis screen. This included negative ANCA and anti-GBM antibodies. Initial treatment for suspected atypical pneumonia with antibiotics yielded no clinical improvement.Over the course of the admission, his symptoms progressively worsened, leading to oxygen dependency with a FiO2 of 40% and episodes of haemoptysis. Suspicions of pulmonary vasculitis arose due to clinical deterioration, prompting consultation with a tertiary vasculitis centre. It was subsequently concluded that the clinical and radiological findings correlated with ANCA-negative pulmonary vasculitis or a rare case of IgA-associated pulmonary capillaritis. Treatment with methylprednisolone and rituximab led to significant improvement, allowing rapid oxygen withdrawal. The patient was discharged with a tapering prednisolone regimen.
Keywords: Medical management; Radiology; Renal system; Respiratory system.
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Zhang Y, Mayor K, Mahdi A. ANCA negative pulmonary vasculitis: a challenging diagnosis. BMJ Case Rep. 2024 Jun 19;17(6):e258766. doi: 10.1136/bcr-2023-258766. PMID: 38901853.
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