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Autopsy case of microscopic polyangiitis with crescentic glomerulonephritis and necrotizing pancreatitis
Author(s) -
Iwasa Satoshi,
Katoh Ryohei
Publication year - 2005
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.2005.01863.x
Subject(s) - medicine , microscopic polyangiitis , pathology , fibrinoid necrosis , disseminated intravascular coagulation , vasculitis , rapidly progressive glomerulonephritis , anti neutrophil cytoplasmic antibody , necrotizing vasculitis , diffuse alveolar hemorrhage , glomerulonephritis , pulmonary hemorrhage , pancreatitis , autopsy , gastroenterology , lung , kidney , disease
Herein is reported the case of an 84‐year‐old woman who initially manifested rapidly progressive glomerulonephritis following a urinary tract infection. Laboratory findings showed a high titer of myeloperoxidase‐antineutrophil cytoplasmic antibody (MPO‐ANCA). Treatment with high‐dose i.v. steroids resulted in clinical recovery and an undetectable MPO‐ANCA titer. Two months later the patient was readmitted in a state of severe shock. Laboratory examination showed the deterioration of renal function, leukocytosis, and coagulation abnormalities consistent with disseminated intravascular coagulation (DIC). The patient died 12 days later. The post‐mortem examination revealed necrotizing pancreatitis due to acute‐stage vasculitis typified by fibrinoid necrosis of the arterioles and venules, and crescentic glomerulonephritis with healed‐stage vasculitis. In the lungs, capillaritis with diffuse alveolar hemorrhage was not evident, but arteriolitis and phlebitis were occasionally seen. This case represents an unusual complication of necrotizing pancreatitis in the setting of microscopic polyangiitis. Thus, it is important to consider reactivation independent of the titer of ANCA in the course of the disease.