BMC Rheumatology (Dec 2020)

The development of rapidly progressive glomerulonephritis associated with both antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane nephritis in the course of nontuberculous mycobacterium infection: a case report

  • Mikiya Kato,
  • Risa Wakiya,
  • Tomohiro Kameda,
  • Kousuke Inoue,
  • Tadashi Sofue,
  • Yusuke Ushio,
  • Koichi Sugihara,
  • Shusaku Nakashima,
  • Hiromi Shimada,
  • Mai Mahmoud Fahmy Mansour,
  • Norimitsu Kadowaki,
  • Hiroaki Dobashi

DOI
https://doi.org/10.1186/s41927-020-00167-y
Journal volume & issue
Vol. 4, no. 1
pp. 1 – 6

Abstract

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Abstract Background Antineutrophil cytoplasmic antibodies (ANCA) and Anti-glomerular basement membrane (GBM) antibodies often induce rapidly progressive glomerulonephritis (RPGN). Some reports have demonstrated RPGN with the sequential appearance of ANCA then anti-GBM antibodies, suggesting that ANCA may induce the development of anti-GBM antibodies. Whereas, many reports have shown that the development of ANCA is associated with various infectious diseases, such as non-tuberculous mycobacterial infection. Case presentation A 65-year-old woman with pulmonary non-tuberculous mycobacterial (NTM) infection was monitored without treatment. One year later, serum myeloperoxidase (MPO)- ANCA were elevated (14.1 U/mL (normal value < 3.0 U/ml)). A high fever and RPGN appeared 1 year later, and serum MPO-ANCAs were 94.1 U/mL. Anti-GBM antibodies were also detected. A renal biopsy revealed crescentic glomerulonephritis with linear deposits of IgG and C3c along the GBM and interstitial inflammation with endarteritis of arterioles. The diagnosis was RPGN associated with anti-GBM nephritis and ANCA-associated vasculitis. Conclusion This report shows that preceding NTM infection may have induced ANCA and anti-GBM antibodies and caused the development of RPGN.

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