Open AccessA case report of granulomatous polyangiitis complicated by tuberculous lymphadenitis
Author(s) -
Yuki Iijima,
Yoichi Kobayashi,
Yoshinori Uchida,
Toshiharu Tsutsui,
Yumiko Kakizaki,
Tsukasa Naganuma,
Katsuhiko Tsukamoto,
Toshio Oyama,
Yoshihiro Miyashita
Publication year - 2018
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000012430
Subject(s) - medicine , glomerulonephritis , anti neutrophil cytoplasmic antibody , microscopic polyangiitis , rapidly progressive glomerulonephritis , granulomatosis with polyangiitis , tuberculosis , renal biopsy , pathology , biopsy , vasculitis , kidney , disease
Rational: Granulomatous polyangiitis (GPA) is a type of vasculitis involving medium and small arteries, typically affecting the upper and lower respiratory tract with coexisting glomerulonephritis. GPA is also characterized by necrotizing granulomatous inflammation and the presence of antineutrophil cytoplasm antibodies (ANCA). So far, various infections have lead to elevation of titers of serum ANCA, making it difficult to diagnose. Patient Concerns: We report a 50-year-old woman who was diagnosed as tuberculous lymphadenitis. During the treatment by anti-tuberculosis (TB) drugs, rapidly progressive renal failure and pleurisy had appeared with elevated titer of PR3-ANCA. Renal biopsy revealed crescentic glomerulonephritis. Diagnosis: Renal biopsy revealed crescentic glomerulonephritis and diagnosis of GPA was made. Interventions: Steroid therapy had been started with continuation of anti-TB drugs. Outcomes: Renal dysfunction had gradually recovered and pleurisy had disappeared with decreasing titer of PR3-ANCA. Lessons: This is the first report of GPA complicated by TB infection. When we encounter a case with rapidly progressive renal failure during the TB infection, complication of GPA should be suspected as 1 of the different diagnosis.