Abstract
A 77-year-old man was referred to our hospital in December 2002 with a diagnosis of chronic renal failure due to diabetic nephropathy. Initial examination showed blood urea nitrogen of 48mg/dL and serum creatinine of 3.3mg/dL, respectively. His renal function gradually decreased. On January, 2004, he complained flu-like symptoms, and his condition abruptly worsened, and anasarca and bilateral pleural effusion developed. He was admitted for starting hemodialysis treatment and further evaluation. During hospitalization, clinical and laboratory findings revealed fever, macrohematuria, and high titers of CRP. Although various detailed examinations failed to find any definitive diagnosis, his condition was improved by administration of antibiotics. He was transferred to an outpatient maintenance hemodialysis unit. Although fever and CRP-positive reaction had been frequently noted, his condition was ameliorated by antibiotic therapy. In June of the same year, chest pain and pleural effusion on the right side developed, and was admitted again for the further examination. Since sustained fever, high CRP level, and general malaise were resistant to several antibiotics or anti-tuberculous agents. A further investigations with respect to malignancy, collagen disease, and other forms of vasculitis revealed a high titer of MPO-ANCA (503 EU). High-dose steroid therapy was initiated, then fever was subsided, CRP decreased, and pleural effusion disappered. His clinical course and laboratory date strongly suggested pleuritis due to MPA.
