Abstract
A 50 year-old-woman had been receiving regular outpatient treatment because of hypertension and glomerulonephritis. She was admitted to our hospital because of fever in May 2008. Initial examination showed WBC 12900/μl, CRP 16.39 mg/dl. Later, pleural effusion appeared rapidly. The property was exudative. She was treated with various antibiotics due to a diagnosis of infectious pleuritis. However, the treatment was not effective. Blood culture, pleural effusion culture, and pleural effusion cytology were negative. Her renal function gradually decreased. The level of serum MPO-ANCA was markedly elevated (48.0 U/ml). Although we could not examine histopathologically because of her bad condition, we diagnosed MPO-ANCA-associated glomerulonephrotis, especially microscopic polyangitis (MPA), secondary renal failure and pleuritis. She was treated with steroid pulse therapy followed by oral prednisolone (40 mg/day). Although she started hemodialysis, the fever subsided immediately. Her condition and laboratorydata were improved. Pleural effusion decreased gradually. Although she became complicated by candida esophagitis, it was resolved with syrup containing amphotericin B. After rehabilitation was performed for loss of muscle strength, she returned home in July 2008. This was a unique case of MPA with only pleuritis and without interstitial pneumonia or alveolar hemorrhage.
