Kaddoussi Rania, Elghali Mourad, Saad Jamel, Chaabane Imene, Cheikhm'hamed Saoussen, Ksissa Souhir, Loued Lobna, Ben Saad Ahmed, Ghribi Wajih, Ghourabi Asma, Joober Sameh, Sakly Nabil, Rouetbi Naceur, Kechida Melek
Pneumology Department, University Hospital FB, Monastir, Tunisia.
Laboratory of Immunology, University Hospital FB, Monastir, Tunisia.
Respir Med Case Rep. 2024 Sep 16;52:102113. doi: 10.1016/j.rmcr.2024.102113. eCollection 2024.
Even though anti-neutrophil cytoplasmic antibodies (ANCA) are frequently linked to ANCA associated vasculitis (AAV), it's important to understand that other illnesses, including lung diseases, can also manifest as ANCA positivity. Finding the incriminated pathology might be difficult.
To report four ANCA-associated cases with a diagnosis problem.
Four patients were recruited from the allergo-pneumology department of the Fattouma Bourguiba University Hospital of Monastir, Tunisia, over two years (2020-2022). Indirect immunofluorescence technique on neutrophil cells (Euroimmun, Germany) was used for ANCA screening with a positivity limit of 1/20. ANCA typing was carried out by a line-blot technique (Euroimmun, Germany).
This case series reports four cases (age range: 41-67 years, sex ratio: 0.3) that presented with pulmonary manifestations associated with ANCA positivity. Two patients had perinuclear ANCA with anti-myeloperoxidase on typing, and two cases had cytoplasmic ANCA with one case of anti-leukocyte proteinase 3 on typing. Final diagnoses were pulmonary tuberculosis (case 1), systemic lupus erythematosus (case 2), bronchiolitis obliterans organizing pneumonia (case 3), and pulmonary aspergillosis with AAV (case 4).
A panel of diagnoses may be evoked in front of positive ANCA, making the diagnosis difficult to determine and requiring multidisciplinary interactions, with imaging and histological investigations having a crucial role in guiding the final decision.
尽管抗中性粒细胞胞浆抗体（ANCA）常与ANCA相关血管炎（AAV）相关，但重要的是要明白，其他疾病，包括肺部疾病，也可能表现为ANCA阳性。找到罪魁祸首的病理可能很困难。
报告4例存在诊断问题的ANCA相关病例。
在两年（2020 - 2022年）期间，从突尼斯莫纳斯提尔法图玛·布尔吉巴大学医院的过敏肺病科招募了4名患者。使用针对中性粒细胞的间接免疫荧光技术（德国欧蒙公司）进行ANCA筛查，阳性阈值为1/20。通过线免疫印迹技术（德国欧蒙公司）进行ANCA分型。
该病例系列报告了4例（年龄范围：41 - 67岁，性别比：0.3）出现与ANCA阳性相关的肺部表现的病例。2例患者在分型时为核周型ANCA伴抗髓过氧化物酶，2例为胞浆型ANCA，其中1例在分型时为抗蛋白酶3。最终诊断分别为肺结核（病例1）、系统性红斑狼疮（病例2）、闭塞性细支气管炎伴机化性肺炎（病例3）以及合并AAV的肺曲霉病（病例4）。
面对ANCA阳性时可能会引发一系列诊断，这使得诊断难以确定，需要多学科协作，其中影像学和组织学检查在指导最终决策中起着关键作用。
