11
MICROSCOPIC POLYANGIITIS ANCA-ASSOCIATED
POLIANGEÍTIS MICROSCÓPICA ASOCIADA A ANCA
Vitorino Modesto dos Santos1,2*, Lister Arruda Modesto dos Santos3
1 Catholic University of Brasília. Adjunct-professor of
Internal Medicine. Brasília-DF, Brazil
2 Armed Forces Hospital. Brasília-DF, Brazil
3. IAMSPE. General Surgery. São Paulo, SP, Brazil
Dear Editor:
We read with interest the case study by Andrade Rada J, et al. of
a 44-year-old female presenting weight loss, muscular weakness,
paresthesia and myalgias in both extremities.1 Her father had
pulmonary tuberculosis more than three decades ago, and she was
treated for peritoneal tuberculosis with 29 years of age. Moreover,
she was for a long time utilizing inhaled steroids to control pulmonary
brosis; and, although asymptomatic, she reacted positively to COVID-
19test ve months ago.1 Laboratory evaluation showed anemia,
hypergammaglobulinemia, proteinuria (1gr/ 24h) positive rheumatoid
factor and cytoplasmic ANCA, and altered kidney function AKIN I.
Renal biopsy revealed extra capillary proliferative glomerulonephritis,
and vasculitis of medium arterial vessels presenting with a consistent
pattern of microscopic polyangiitis.1 The authors stressed the successful
use of methylprednisolone, prednisone and rituximab, in addition to the
early diagnosis and prompt institution of immunomodulatory therapy.1
As the vasculitis associated with ANCA are rare entities with high risk of
complications and high mortality rate, even treated; and may pose
challenging differential diagnosis with pulmonary tuberculosis, it seems
opportune to comment on two Brazilian cases.2,3
Amaral BC, et al. reported a 62-year-old hypertensive male with
microscopic polyangiitis causing fever of undetermined origin, who
had pulmonary brosis with “tree-in-bud” images, a strong reactive skin
test for tuberculosis, and negative blood cultures.2 He had malaria and
contact with a tuberculosis carrier in the infancy; cutaneous leishmaniasis
at his 35 years; and with 59 years a strong skin test for tuberculosis.
Complementary tests showed hematuria, microalbuminuria, erythrocyte
sedimentation rate: 106 mm/h, C-reactive protein: 24.6 mg/dL, and
pANCA (antimyeloperoxidase).2 Lung biopsy ruled out tuberculosis
and showed a pattern of microscopic polyangiitis, that was treated by
immunosuppressive doses of cyclophosphamide and methylprednisolone.
The authors emphasized the good outcome of a vasculitis with lung
changes mimicking an infection, but is not included among the causes
of fever with undetermined etiology.2 Santos VM, et al. described the
case of a 76-year-old hypertensive female with longstanding sinonasal
disease, and had a recent rapidly progressive glomerulonephritis.3 The
imaging evaluations of her pleural and pulmonary elds were found
unremarkable. She had proteinuria: 455 mg/24 h, creatinine clearance:
58 mL/min/1.73 m2, and pANCA 1:20; renal biopsy study revealed
glomerular hyper-cellularity, segmental capillary retractions and
sclerosis, debris and synechiae, surrounded by bro cellular crescents.3
She underwent prednisone and cyclophosphamide schedule with a
rapid improvement; the authors highlighted the successful therapeutic
approach due a prompt treatment, and ideal management by internists,
nephrologists, otolaryngologists, and rheumatologists. They commented
on the hypothesis of this entity related to chronic sinonasal disorders.3
* Corresponding author:
Vitorino Modesto dos Santos
E-mail: vitorinomodesto@gmail.com.
Key words: ANCA, Glomerulonephritis, Microscopic polyangiitis, Tuberculosis
Palabras clave: ANCA, Glomerulonefritis, Poliangeítis microscópica, Tuberculosis
Forma de citar este artículo: Santos
VM, Santos LAM. MICROSCOPIC
POLYANGIITIS ANCA-ASSOCIATED. Med
Vozandes. 2023; 34 (2): 11-12
ORCID ID:
Vitorino Modesto dos Santos:
orcid.org/0000-0002-7033-6074
Lister Arruda Modesto dos Santos:
orcid.org/0000-0003-4647-4044
LETTER TO EDITOR
Conflict of interest: The authors have full
freedom of manuscript preparation, and there were no
potential conicts of interest.
Financial disclosure: The authors have no nan-
cial relationships relevant to this article to disclose.
CRediT – Contributor Roles Taxonomy:
Conceptualización, Curación de datos, Análisis formal,
Investigación, Metodología, Visualización, Redacción
– borrador original, Redacción – revisión y edición:
VMDS – LAVMDS.
Este artículo está bajo una
licencia de Creative Com-
mons de tipo Reconocimien-
to – No comercial – Sin obras
derivadas 4.0 International.
DOI: 10.48018/RMVv34i21
Received: 26 – Ago – 2023
Accepted: 22 – Sep – 2023
Publish: 01 – Jan – 2024
Revista Médica Vozandes
Volumen 34, Número 2, 2023
12 Revista Médica Vozandes
Volumen 34, Número 2, 2023
The authors are in accordance about the possible
occurrence of underdiagnosis, misdiagnosis and
underreported diagnoses of this uncommon condition.
The clinical hypothesis of ANCA associated microscopic
polyangiitis is usually a challenging task due to the
nonspecic manifestations, in special sinonasal
disturbances or glomerulonephritis, which are not
infrequent among individuals of both genders and
diverse age groups. Additional concerns may be due
to reported casual relationships with tuberculous close
contacts, antecedent and/or lung images compatible
with pulmonary tuberculosis sequels.
MICROSCOPIC POLYANGIITIS ANCA-ASSOCIATED Modesto dos Santos VV, et al.
Referencias
1. Andrade Rada J, Tutasi Bahamonde M, Camacho Merchán C, Villarreal
Juris A. Poliangeítis microscópica asociado a positividad para Anca-C:
reporte de caso. Rev Med Vozandes. 2023;34(1):47-51.
2. Amaral BC, Pedrosa DL, Santos VM, Daameche LN, Alves TB. Microsco-
pic polyangiitis and fever of undetermined origin. Rev Med Saúde Brasília.
2019;8(2):114-23.
3. Santos VM, Arruda Junior ZC, Ribeiro KRA, Santos UM, Brandão BBV, Moura
LAR. Upper airway changes and rapid progressive glomerulonephritis in
an old woman. Brasília Med. 2014;51(2):185-189.
