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01-11-2010 | Case Report

Microscopic polyangiitis initiated with liver dysfunction, calf pain and fever of unknown origin

Authors: Kei Ohnuma, Osamu Hosono, Tomoki Katayose, Noritada Yoshikawa, Hiroshi Kawasaki, Takeshi Fujii, Naoki Oyaizu, Hirotoshi Tanaka, Chikao Morimoto

Published in: Rheumatology International | Issue 12/2010

Abstract

We report herein a case of microscopic polyangiitis (MPA), presenting onset with a spiking fever, liver/biliary dysfunction without jaundice and calf pain without elevation of serum creatine phosphokinase. During 1 month of careful examinations for initial diagnosis, the patient developed renal dysfunction and pulmonary hemorrhage. Based on the results of positive MPO-ANCA, renal and pulmonary involvements, the patient was diagnosed with MPA and treated with high-dose prednisolone and oral cyclophosphamide. Soon after initiation of the treatment, symptoms such as fever, calf pain, liver/biliary dysfunction and renal dysfunction disappeared with decrease of MPO-ANCA titer to the normal level.

Jennette JC, Falk RJ (1997) Small-vessel vasculitis. N Engl J Med 337(21):1512–1523CrossRefPubMed

Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192CrossRefPubMed

Choi HK, Merkel PA, Walker AM, Niles JL (2000) Drug-associated antineutrophil cytoplasmic antibody-positive vasculitis: prevalence among patients with high titers of antimyeloperoxidase antibodies. Arthritis Rheum 43(2):405–413CrossRefPubMed

Kallenberg CG, Heeringa P, Stegeman CA (2006) Mechanisms of disease: pathogenesis and treatment of ANCA-associated vasculitides. Nat Clin Pract Rheumatol 2(12):661–670CrossRefPubMed

Falk RJ, Jennette JC (1988) Anti-neutrophil cytoplasmic autoantibodies with specificity for myeloperoxidase in patients with systemic vasculitis and idiopathic necrotizing and crescentic glomerulonephritis. N Engl J Med 318(25):1651–1657CrossRefPubMed

van der Woude FJ, Rasmussen N, Lobatto S, Wiik A, Permin H, van Es LA et al (1985) Autoantibodies against neutrophils and monocytes: tool for diagnosis and marker of disease activity in Wegener’s granulomatosis. Lancet 1(8426):425–429PubMed

Mansi IA, Opran A, Rosner F (2002) ANCA-associated small-vessel vasculitis. Am Fam Physician 65(8):1615–1620PubMed

Guillevin L, Durand-Gasselin B, Cevallos R, Gayraud M, Lhote F, Callard P et al (1999) Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 42(3):421–430CrossRefPubMed

Hashimoto H (2002) Clinical manual for vasculitis. Research Group of Intractable Basic, Ministry of Health Labor and Welfare of Japan, Tokyo

10.

Ozaki S, Nakabayashi K, Tomino Y, Koyama T (2006) A prospective, open-labeled, and multi-center trial of standard protocols for MPO-ANCA-associated vasculitis by Japanese study group for MPO-ANCA-associated vasculitis (JMAAV). Annual report 2005 of the Research Group for Intractable Vasculitis, Ministry of Health, Labor, and Welfare of Japan

11.

Savage CO, Winearls CG, Evans DJ, Rees AJ, Lockwood CM (1985) Microscopic polyarteritis: presentation, pathology and prognosis. Q J Med 56(220):467–483PubMed

12.

Goritsas CP, Repanti M, Papadaki E, Lazarou N, Andonopoulos AP (1997) Intrahepatic bile duct injury and nodular regenerative hyperplasia of the liver in a patient with polyarteritis nodosa. J Hepatol 26(3):727–730CrossRefPubMed

13.

Nishiya K, Chijiwa T, Okabayashi T, Ito H, Hashimoto K, Moriki T (2000) A case of ANCA-positive idiopathic crescentic glomerulonephritis initiated with fever and liver dysfunction. Rinsho Byori 48(6):561–565PubMed

14.

Nakamoto T, Yoshikawa M, Nakatani T, Yamane Y, Iwasawa S, Matsumoto M et al (2000) Microscopic polyangiitis that presented liver dysfunction prior to noted renal manifestations. Intern Med 39(6):517–521CrossRefPubMed

15.

Takebayashi K, Aso Y, Kitamura H, Sakurai Y, Wakabayashi S, Inukai T (2004) Microscopic polyangiitis presenting with liver dysfunction preceding rapidly progressive necrotizing glomerulonephritis. South Med J 97(9):911–914CrossRefPubMed

16.

Bissuel F, Bizollon T, Dijoud F, Bouletreau P, Cordier JF, Chazot C et al (1992) Pulmonary hemorrhage and glomerulonephritis in primary biliary cirrhosis. Hepatology 16(6):1357–1361CrossRefPubMed

17.

Amezcua-Guerra LM, Prieto P, Bojalil R, Pineda C, Amigo MC (2006) Microscopic polyangiitis associated with primary biliary cirrhosis: a causal or casual association? J Rheumatol 33(11):2351–2353PubMed

18.

Iannone F, Falappone P, Pannarale G, Gentile A, Grattagliano V, Covelli M et al (2003) Microscopic polyangiitis associated with primary biliary cirrhosis. J Rheumatol 30(12):2710–2712PubMed

19.

Nakamura T, Kawagoe Y, Ueda Y, Koide H (2004) Antineutrophil cytoplasmic autoantibody-associated rapidly progressive glomerulonephritis in a patient with primary biliary cirrhosis. Am J Med Sci 328(3):176–179CrossRefPubMed

20.

Seibold F, Slametschka D, Gregor M, Weber P (1994) Neutrophil autoantibodies: a genetic marker in primary sclerosing cholangitis and ulcerative colitis. Gastroenterology 107(2):532–536PubMed

21.

Seibold F, Weber P, Klein R, Berg PA, Wiedmann KH (1992) Clinical significance of antibodies against neutrophils in patients with inflammatory bowel disease and primary sclerosing cholangitis. Gut 33(5):657–662CrossRefPubMed

22.

Zauli D, Baffoni L, Cassani F, Fusconi M, Lenzi M, Ballardini G et al (1992) Antineutrophil cytoplasmic antibodies in primary sclerosing cholangitis, ulcerative colitis, and autoimmune diseases. Gastroenterology 102(3):1088–1090PubMed

23.

Zauli D, Ghetti S, Grassi A, Descovich C, Cassani F, Ballardini G et al (1997) Anti-neutrophil cytoplasmic antibodies in type 1 and 2 autoimmune hepatitis. Hepatology 25(5):1105–1107CrossRefPubMed

24.

Michaels A, Levy C (2008) The medical management of primary sclerosing cholangitis. Medscape J Med 10(3):61PubMed

25.

Sugiura M, Koike H, Iijima M, Mori K, Hattori N, Katsuno M et al (2006) Clinicopathologic features of nonsystemic vasculitic neuropathy and microscopic polyangiitis-associated neuropathy: a comparative study. J Neurol Sci 241(1–2):31–37CrossRefPubMed

26.

Cohen MD, Ginsburg WW (1990) Polymyalgia rheumatica. Rheum Dis Clin North Am 16(2):325–339PubMed

27.

Cilursu AM, Goeken J, Olson RR (1991) Detection of antineutrophil cytoplasmic antibody in a patient with l-tryptophan-induced eosinophilia-myalgia syndrome. Ann Rheum Dis 50(11):817–819CrossRefPubMed

28.

Smith SA, Roelofs RI, Gertner E (1990) Microangiopathy in the eosinophilia-myalgia syndrome. J Rheumatol 17(11):1544–1550PubMed

29.

Schnabel A, Gross WL, Berg PA, Klein R, Lehnert H (1995) Antineutrophil cytoplasmic antibodies and the eosinophilia myalgia syndrome. Ann Rheum Dis 54(3):233CrossRefPubMed

30.

Nakamura T, Tomoda K, Yamamura Y, Tsukano M, Honda I, Iyama K (2003) Polyarteritis nodosa limited to calf muscles: a case report and review of the literature. Clin Rheumatol 22(2):149–153CrossRefPubMed

31.

Iwamasa K, Komori H, Niiya Y, Hasegawa H, Sakai I, Fujita S et al (2001) A case of polyarteritis nodosa limited to both calves with a low titer of MPO-ANCA. Ryumachi 41(5):875–879PubMed

32.

Joh K, Muso E, Shigematsu H, Nose M, Nagata M, Arimura Y et al (2008) Renal pathology of ANCA-related vasculitis: proposal for standardization of pathological diagnosis in Japan. Clin Exp Nephrol 12(4):277–291CrossRefPubMed

33.

Wen YK, Chen ML (2006) Microscopic polyangiitis atypically presenting with tubulointerstitial nephritis. Clin Nephrol 65(5):356–360PubMed

34.

Wen YK, Chen ML (2006) Transformation from tubulointerstitial nephritis to crescentic glomerulonephritis: an unusual presentation of ANCA-associated renal vasculitis. Ren Fail 28(2):189–191CrossRefPubMed

35.

Savige J, Gillis D, Benson E, Davies D, Esnault V, Falk RJ et al (1999) International consensus statement on testing and reporting of antineutrophil cytoplasmic antibodies (ANCA). Am J Clin Pathol 111(4):507–513PubMed

36.

Mandl LA, Solomon DH, Smith EL, Lew RA, Katz JN, Shmerling RH (2002) Using antineutrophil cytoplasmic antibody testing to diagnose vasculitis: can test-ordering guidelines improve diagnostic accuracy? Arch Intern Med 162(13):1509–1514CrossRefPubMed

Title: Microscopic polyangiitis initiated with liver dysfunction, calf pain and fever of unknown origin
Authors: Kei Ohnuma
Osamu Hosono
Tomoki Katayose
Noritada Yoshikawa
Hiroshi Kawasaki
Takeshi Fujii
Naoki Oyaizu
Hirotoshi Tanaka
Chikao Morimoto
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Rheumatology International / Issue 12/2010
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-009-1121-2

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