Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease characterized by necrotizing inflammation of the small blood vessels. ANCA-associated vasculitis is subclassified into three variants: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and microscopic polyangiitis (MPA). Myeloperoxidase (MPO) ANCA is a marker antibody for MPA. Interstitial pneumonia (IP) is occasionally complicated with MPA. However, only a few cases of idiopathic IP develop MPO-ANCA-positive conversion and MPA. Therefore, we present a case of a 70-year-old Japanese man with idiopathic IP who developed MPO-ANCA-positive conversion and MPA. We performed renal biopsy, which revealed pauci-immune crescentic glomerulonephritis. The patient was treated with intravenous methylprednisolone pulse therapy and oral prednisone, and the patient’s laboratory data gradually improved with steroid therapy. The association between the production of MPO-ANCA and IP remains unclear, and the present case suggests that IP plays a role in inducing MPO-ANCA production. Patients with idiopathic IP should be followed-up carefully for an examination of increased MPO-ANCA levels and MPA development. In addition, early gastric cancer was detected during upper gastrointestinal endoscopy in our case, and it could also be important not to miss malignancy in patients with ANCA-associated vasculitis.
Similar content being viewed by others
References
Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65:1–11.
Kitching AR, Anders HJ, Basu N, et al. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020;6:71.
Jennette JC, Nachman PH. ANCA Glomerulonephritis and Vasculitis. Clin J Am Soc Nephrol. 2017;12:1680–91.
Sebastiani M, Manfredi A, Vacchi C, et al. Epidemiology and management of interstitial lung disease in ANCA-associated vasculitis. Clin Exp Rheumatol. 2020;38(Suppl 124):221–31.
ANCA associated vasculitis: The Guide for the diagnosis and treatment of Interstitial Lung Disease associated with Connective Tissue Disease,. Medical Review Co. Ltd. 2020;2020:135–40.
Ando M, Miyazaki E, Ishii T, et al. Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis. Respir Med. 2013;107:608–15.
Kagiyama N, Takayanagi N, Kanauchi T, Ishiguro T, Yanagisawa T, Sugita Y. Antineutrophil cytoplasmic antibody-positive conversion and microscopic polyangiitis development in patients with idiopathic pulmonary fibrosis. BMJ Open Respir Res. 2015;2:e000058.
Oiwa H, Ooi K, Oyama T, Sugyama E. Idiopathic interstitial pneumonia as a possible cause of antineutrophil cytoplasmic antibody-associated vasculitis: a case report. Arch Rheumatol. 2018;33:89–92.
Maher TM, van der Aar EM, Van de Steen O, et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of GLPG1690, a novel autotaxin inhibitor, to treat idiopathic pulmonary fibrosis (FLORA): a phase 2a randomised placebo-controlled trial. Lancet Respir Med. 2018;6:627–35.
Ahn SS, Han M, Yoo J, et al. Risk of cancers in antineutrophil cytoplasmic antibody-associated vasculitis: results from the Korea National Health Insurance Claims Database 2010–2018. J Clin Med. 2019;8:1871.
Heijl C, Westman K, Höglund P, Mohammad AJ. Malignancies in patients with antineutrophil cytoplasmic antibody-associated vasculitis: a population-based cohort study. J Rheumatol. 2020;47:1229–37.
Hosoya Y, Minota S, Lefor A, et al. Resolution of anti-neutrophil cytoplasmic antibody-associated vasculitis after resection of gastric cancer. Mod Rheumatol. 2010;20:102–5.
Abe H, Momose S, Takeuchi T. Microscopic polyangitis complicating double carcinoma of the stomach and duodenum: improvement after the resection of these carcinomas. Rheumatol Int. 2011;31:105–8.
Funding
This work was supported in part by Grants-in-Aid for Scientific Research (19H03677, 19K21596, and 20K08612) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT), and the Takeda Research Foundation.
Author information
Authors and Affiliations
Contributions
S.N. contributed to data acquisition and manuscript writing. AE TH ME and TM critically revised the article for important intellectual content. All authors have read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The Division of Integrative Renal Replacement Therapy is financially supported by Chugai Pharmaceutical, Terumo, and JMS (T. H. and T. M.). The other authors declare that they have no conflicts of interest.
Ethical approval
This work was approved by the Institutional Review Board of Tohoku Medical and Pharmaceutical University Hospital (2021–4-072). This study was conducted in accordance with the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Informed consent
Informed consent was obtained from the patient in this work.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Nakayama, S., Endo, A., Hirose, T. et al. MPO-ANCA-positive conversion and microscopic polyangiitis development in idiopathic interstitial pneumonia: a case report. CEN Case Rep 12, 39–44 (2023). https://doi.org/10.1007/s13730-022-00717-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13730-022-00717-y