Ubanatu Chukwunonso B, Akpoviroro Ogheneyoma, Queeneth Uwandu
Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, USA.
Cureus. 2025 Apr 22;17(4):e82778. doi: 10.7759/cureus.82778. eCollection 2025 Apr.
Microscopic polyangiitis (MPA) is a rare, necrotizing vasculitis that primarily affects small-sized blood vessels, with a predilection for the upper and lower respiratory tract and the kidneys. It is commonly associated with the presence of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA), often targeting myeloperoxidase (MPO), and typically presents with renal impairment, pulmonary symptoms, or systemic features such as fatigue and weight loss. We report the case of a 76-year-old Caucasian woman who presented with anemia, dark stools, and acute kidney injury (AKI) but lacked significant pulmonary symptoms. Her evaluation revealed chronic sinusitis on imaging and pauci-immune necrotizing glomerulonephritis (GN) on kidney biopsy, with perinuclear antineutrophil cytoplasmic antibody (p-ANCA) positivity and limited crescent formation. Despite the absence of overt respiratory or constitutional symptoms, her diagnosis of MPA was confirmed, and she was initiated on rituximab therapy with plans for outpatient rheumatology and nephrology follow-up. This case highlights the importance of considering vasculitis in elderly patients presenting with unexplained renal dysfunction and subtle upper respiratory findings, even in the absence of classic systemic features.
显微镜下多血管炎（MPA）是一种罕见的坏死性血管炎，主要累及小血管，好发于上、下呼吸道及肾脏。它通常与核周抗中性粒细胞胞浆抗体（p-ANCA）的存在有关，该抗体常靶向髓过氧化物酶（MPO），典型表现为肾功能损害、肺部症状或全身症状，如疲劳和体重减轻。我们报告一例76岁的白种女性病例，该患者表现为贫血、黑便和急性肾损伤（AKI），但缺乏明显的肺部症状。影像学检查显示其患有慢性鼻窦炎，肾脏活检显示为寡免疫坏死性肾小球肾炎（GN），核周抗中性粒细胞胞浆抗体（p-ANCA）呈阳性，新月体形成有限。尽管没有明显的呼吸道或全身症状，但她的MPA诊断得以确诊，并开始接受利妥昔单抗治疗，计划进行门诊风湿科和肾内科随访。该病例强调了在老年患者出现不明原因的肾功能不全和轻微上呼吸道表现时，即使没有典型的全身症状，也需考虑血管炎的重要性。
