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Renal medicine
ANCA negative pulmonary vasculitis: a challenging diagnosis
  1. Yimeng Zhang1,2,
  2. Kara Mayor2 and
  3. Amar Mahdi2
  1. 1 Renal Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  2. 2 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Yimeng Zhang; yimeng.zhang{at}nhs.net

Abstract

A man in his 40s with end-stage kidney disease due to IgA nephropathy and receiving peritoneal dialysis presented with a 1-week history of breathlessness, cough and nosebleeds. CT scan of the chest revealed ground glass changes while blood tests indicated elevated inflammatory markers and a negative vasculitis screen. This included negative ANCA and anti-GBM antibodies. Initial treatment for suspected atypical pneumonia with antibiotics yielded no clinical improvement.

Over the course of the admission, his symptoms progressively worsened, leading to oxygen dependency with a FiO2 of 40% and episodes of haemoptysis. Suspicions of pulmonary vasculitis arose due to clinical deterioration, prompting consultation with a tertiary vasculitis centre. It was subsequently concluded that the clinical and radiological findings correlated with ANCA-negative pulmonary vasculitis or a rare case of IgA-associated pulmonary capillaritis. Treatment with methylprednisolone and rituximab led to significant improvement, allowing rapid oxygen withdrawal. The patient was discharged with a tapering prednisolone regimen.

  • Radiology
  • Renal system
  • Respiratory system
  • Medical management

https://doi.org/10.1136/bcr-2023-258766

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    Footnotes

    • Contributors All authors (YZ, KM and AM) were involved in the clinical care of the patient. The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: YZ, KM and AM. The following authors gave final approval of the manuscript: YZ, KM and AM.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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