A tale of two vasculitides: biopsy-proven giant cell arteritis followed by the independent development of renal-limited microscopic polyangiitis
- 1 Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
- 2 Medicine/Nephrology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
- 3 Medicine/Rheumatology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
- Correspondence to Dr Deborah R Alpert,
- Accepted 24 March 2017
- Published 21 April 2017
We describe an 80-year-old woman who presented with headaches, bilateral jaw claudication and visual symptoms. She was diagnosed with giant cell arteritis, which was confirmed by temporal artery biopsy. She was treated with high-dose prednisone followed by a slow taper, with complete resolution of symptoms. Approximately 4 years later, she developed progressively worsening renal function associated with haematuria. Serological workup revealed a high-titre perinuclear antinuclear cytoplasmic antibody and antibodies to myeloperoxidase. Renal biopsy demonstrated a pauci-immune focal crescentic glomerulonephritis. Extensive review of systems, physical exam and diagnostic studies demonstrated no evidence of extra-renal disease, and she was diagnosed with renal-limited microscopic polyangiitis. High-dose prednisone was resumed, but she refused treatment with either cyclophosphamide or rituximab due to concern for toxicity. Her prednisone dose was tapered and renal function stabilised. Our case highlights the need to recognise the successive occurrence of two distinct vasculitides in a single patient and monitor accordingly.
Contributors RZ conceptualized and drafted the manuscript and assisted with the management of the patient.
MP conceptualized and edited the manuscript and provided important inputs on the patient's renal disease. He also managed the patient. DRA
conceptualized and assisted with drafting and editing the manuscript and also managed the patient.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed