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ANCA associated glomerulonephritis in tuberculosis: a paradoxical reaction
  1. Shane OBrien1,
  2. Brenda Griffin2,
  3. Anne Marie McLaughlin1 and
  4. Joseph Keane1
  1. 1Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
  2. 2Department of Renal Medicine, St James's Hospital, Dublin, Ireland
  1. Correspondence to Dr Shane OBrien; Shaneobrien2{at}hotmail.com

Abstract

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.

  • TB and other respiratory infections
  • immunology
  • acute renal failure

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Footnotes

  • Contributors SOB contributed to the concept of the case report, wrote the body of the text and multiple revisions, is the guarantor of the work and is the first author. JK contributed to the conception of the case report, the theoretical hypothesis regarding paradoxical reactions in this setting and revising and editing drafts of paper. BG contributed to the writing and editing of the diagnosis and management section specifically regarding glomerulonephritis as this is her area of expertise. She then was involved in reviewing revised drafts and editing. AMM substantially contributed to the concept of the case report, background and management sections as she was very familiar with the case and also is an expert in tuberculosis. She was involved in revising drafts and suggested multiple edits regarding tables outlining results and phrasing of certain points. All authors were involved in the patient’s care, have agreed upon the final draft and have agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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