A rare case of double-antibody-positive renal vasculitis: Are we in a hurry to start tuberculosis medicines?

Abstract

Double antibody positive renal vasculitis (anti GBM antibody and pANCA) is a rare form of small vessel vasculitis associated with poor outcome. It is difficult to decide which antibody is the precursor in these cases. We report here such a rare case of double antibody positive renal vasculitis which was started on anti tubercular medicine for a positive mantoux test and interferon gamma release assay. The possible reasons for these antibodies in this may be a complication of COVID-19 infection or vaccine, adverse drug effect of antitubercular medicines or a paradoxical reaction during the tuberculosis treatment. The patient could not survive beyond two months of diagnosis because of rapidly declining renal functions. This case highlights the importance of a meticulous clinical approach, supports two week tuberculosis medicines trial and an early and careful dealing of non responders during tuberculosis treatment especially in patients whose diagnosis is not microbiologically confirmed.

Keywords

• antiglomerular basement membrane antibody
• antineutrophil cytoplasmic antibody
• antiglomerular basement membrane disease
• double-antibody-positive vasculitis
• interferon-gamma release assay
• mantoux test
• tuberculosis