A Case of Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis Superimposed on Post-streptococcal Acute Glomerulonephritis

A 44-year-old woman was admitted due to gross hematuria and progressive renal dysfunction. Poststreptococcal acute glomerulonephritis (PSAGN) was suspected due to her elevated anti-streptolysin O and anti-streptokinase titers and hypocomplementemia. A renal biopsy showed crescent formation and endoc...

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Bibliographic Details
Published in:Internal Medicine 2022, pp.8690-21
Main Authors: Kamijo, Natsumi, Mii, Akiko, Aratani, Sae, Kashiwagi, Tetsuya, Oda, Takashi, Shimizu, Akira, Sakai, Yukinao
Format: Article
Language:English
Subjects:
ANCA-associated vasculitis
MPO-ANCA
neutrophil extra cellular trap
post-streptococcal acute glomerulonephritis
rapidly progressive glomerulonephritis
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Summary:A 44-year-old woman was admitted due to gross hematuria and progressive renal dysfunction. Poststreptococcal acute glomerulonephritis (PSAGN) was suspected due to her elevated anti-streptolysin O and anti-streptokinase titers and hypocomplementemia. A renal biopsy showed crescent formation and endocapillary hypercellularity with neutrophil infiltrate. An immunofluorescence analysis showed granular immunoglobulin G and C3 deposition, suggesting immune-complex-type glomerulonephritis. However, myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA) was positive, and peritubular capillaritis was observed. Furthermore, citrullinated histone H3-positive neutrophils were detected as markers for neutrophil extracellular trap formation. Therefore, she was diagnosed with ANCA-associated vasculitis superimposed on PSAGN that was the main contributor to her progressive renal injury.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.8690-21