OBrien Shane, Griffin Brenda, McLaughlin Anne Marie, Keane Joseph
Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
Department of Renal Medicine, St James's Hospital, Dublin, Ireland.
BMJ Case Rep. 2021 Jun 15;14(6):e241904. doi: 10.1136/bcr-2021-241904.
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.
我们报告一例在肺结核（TB）治疗过程中出现的抗中性粒细胞胞浆抗体（ANCA）相关的快速进展性肾小球肾炎病例。一名42岁女性因药物敏感型肺结核接受治疗，出现症状和影像学特征的矛盾性恶化。她的HIV检测呈阴性。入院时明显存在伴有肾小球肾炎特征的严重急性肾损伤。血清中存在核周型ANCA和抗髓过氧化物酶抗体，肾活检结果符合ANCA相关血管炎。该患者接受抗结核治疗和免疫抑制治疗（皮质类固醇和霉酚酸酯）后成功治愈，随后临床症状改善，肾功能也有所好转。我们认为这是首例描述结核病治疗期间矛盾反应与ANCA相关肾小球肾炎之间关联的病例。
