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 2022/10/01, Vol.61(19), pp.2917-2923
Main Authors: Kamijo, Natsumi, Mii, Akiko, Aratani, Sae, Kashiwagi, Tetsuya, Oda, Takashi, Shimizu, Akira, Sakai, Yukinao
Format: Article
Language:English
Subjects:
ANCA-associated vasculitis
Antineutrophil cytoplasmic antibodies
Biopsy
Case Report
Citrulline
Glomerulonephritis
Hematuria
Histone H3
Histones
Hypocomplementemia
Immunofluorescence
Immunoglobulin G
Internal medicine
Leukocytes (neutrophilic)
MPO-ANCA
neutrophil extra cellular trap
Peroxidase
post-streptococcal acute glomerulonephritis
rapidly progressive glomerulonephritis
Renal function
Streptococcus
Streptokinase
Vasculitis
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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