Zhang X, Zhao GB, Li LK, Wang WD, Lin HL, Yang N. Myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis with headache and kidney involvement at presentation and with arthralgia at relapse: A case report. World J Clin Cases 2023; 11(21): 5167-5172 [PMID: 37583854 DOI: 10.12998/wjcc.v11.i21.5167]
Corresponding Author of This Article
Ning Yang, Chief Doctor, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning Province, China. kidney2003@126.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2023; 11(21): 5167-5172 Published online Jul 26, 2023. doi: 10.12998/wjcc.v11.i21.5167
Myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis with headache and kidney involvement at presentation and with arthralgia at relapse: A case report
Xue Zhang, Guang-Ben Zhao, Long-Kai Li, Wei-Dong Wang, Hong-Li Lin, Ning Yang
Xue Zhang, Graduate School, Dalian Medical University, Dalian 116011, Liaoning Province, China
Xue Zhang, Guang-Ben Zhao, Long-Kai Li, Wei-Dong Wang, Hong-Li Lin, Ning Yang, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Yang N and Lin HL were responsible for the study design, supervised the data collection and analysis, and contributed to editing the manuscript; Zhang X, Zhao GB, and Li LK contributed to patient diagnosis, treatment, and follow-up; Zhang X and Zhao GB contributed to drafting and editing the manuscript; Wang WD contributed to assessing renal pathology; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning Yang, Chief Doctor, Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning Province, China. kidney2003@126.com
Received: May 10, 2023 Peer-review started: May 10, 2023 First decision: May 31, 2023 Revised: June 12, 2023 Accepted: July 6, 2023 Article in press: July 6, 2023 Published online: July 26, 2023
Abstract
BACKGROUND
Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis (AAV) experience different manifestations at the initial onset and relapse. However, such cases of different initial and relapse manifestations have not been reported in myeloperoxidase (MPO)-AAV patients.
CASE SUMMARY
A 52-year-old woman was admitted to our hospital because of headache. Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria, serum creatinine of 243 μmol/L, anti-MPO antibody titer of > 400 RU/mL, and positive perinuclearantineutrophil cytoplasmic antibody. Renal biopsy showed pauci-immune crescentic glomerulonephritis. The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality. Therefore, MPO-AAV was diagnosed. Corticosteroids, plasmapheresis, and cyclophosphamide as induction therapy and mycophenolate mofetil (MMF) as maintenance therapy were administered. The patient’s headache disappeared; serum creatinine returned to normal; complete remission of microscopic hematuria and proteinuria was observed. Anti-MPO antibody titer reached normal limits after immunosuppressive treatment. Twenty-five months after stopping the immunosuppressive treatment, the patient relapsed with arthralgia, without neurological or renal involvement. The patient’s arthralgia improved after treatment with prednisone and MMF.
CONCLUSION
We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement. However, relapse presented with only arthralgia, which was completely different from the initial manifestations. This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission, when clinical manifestations at relapse are different from those at onset. Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.
Core Tip: We report a rare case of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody-associated vasculitis (AAV) who initially presented with headache and kidney involvement. However, relapse presented with only arthralgia, which was completely different from the initial manifestations. This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission, when clinical manifestations at relapse are different from those at onset. Prednisone and mycophenolate mofetil may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.
