Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis with a unique imaging presentation of organizing pneumonia: A case report

Kazufumi Takada, MD; Atsushi Miyamoto, MD, PhD; Hiroshi Nakahama, MD; Shuhei Moriguchi, MD; Yui Takahashi, MD; Kazumasa Ogawa, MD; Kyoko Murase, MD; Shigeo Hanada, MD, PhD; Nasa Morokawa, MD, PhD; Atsuko Kurosaki, MD; Takeshi Fujii, MD, PhD; Eiko Hasegawa, MD; Hisashi Takaya, MD; Daiya Takai, MD, PhD

Respiratory Medicine Case Reports (Jan 2020)

Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis with a unique imaging presentation of organizing pneumonia: A case report

Kazufumi Takada, MD,
Atsushi Miyamoto, MD, PhD,
Hiroshi Nakahama, MD,
Shuhei Moriguchi, MD,
Yui Takahashi, MD,
Kazumasa Ogawa, MD,
Kyoko Murase, MD,
Shigeo Hanada, MD, PhD,
Nasa Morokawa, MD, PhD,
Atsuko Kurosaki, MD,
Takeshi Fujii, MD, PhD,
Eiko Hasegawa, MD,
Hisashi Takaya, MD,
Daiya Takai, MD, PhD

Affiliations

Kazufumi Takada, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Atsushi Miyamoto, MD, PhD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan; Corresponding author. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
Hiroshi Nakahama, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Shuhei Moriguchi, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Yui Takahashi, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Kazumasa Ogawa, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Kyoko Murase, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Shigeo Hanada, MD, PhD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Nasa Morokawa, MD, PhD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Atsuko Kurosaki, MD: Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-tuberculosis Association, 3-1-24 Matsuyama Kiyose-shi, Tokyo, 204-8522, Japan
Takeshi Fujii, MD, PhD: Department of Pathology, Toranomon Hospital (Branch), 1-3-1 Kajigaya Takatsu-ku, Kawasaki-shi, Kanagawa, 213-8587, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan
Eiko Hasegawa, MD: Department of Nephrology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Hisashi Takaya, MD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
Daiya Takai, MD, PhD: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan

Journal volume & issue: Vol. 31
p. 101294

Abstract

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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of blood vessel inflammation diseases of autoimmune origin. Myeloperoxidase (MPO) ANCA is closely related to ANCA associated AAV. The MPO-ANCA positive AAV patients have lung involvement at high rates; however, there are only a few reported cases with organizing pneumonia (OP). A 78-year-old man was presented to our hospital due to a fever of 38 °C despite a whole month of antibiotics treatment. Chest computed tomography image revealed restricted consolidations visible in the middle lobe of the right lung and the upper lobe of the left lung, which suggested an OP pattern. MPO-ANCA and urine occult blood tests were positive. Histopathological examination of the transbronchial biopsy revealed OP and mucus plug. Histological findings on renal biopsy showed necrotizing glomerulonephritis related to AAV. The patient was diagnosed with MPO-ANCA positive AAV and was treated with systemic corticosteroid therapy, from which he recovered rapidly. Thus, when diagnosing OP, the possibility of AAV should be considered by ordering patients’ serum ANCA and occult hematuria tests.

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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