A Case of Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis Superimposed on Post-streptococcal Acute Glomerulonephritis

Natsumi Kamijo; Akiko Mii; Sae Aratani; Tetsuya Kashiwagi; Takashi Oda; Akira Shimizu; Yukinao Sakai

doi:10.2169/internalmedicine.8690-21

This article has now been updated. Please use the final version.

A Case of Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis Superimposed on Post-streptococcal Acute Glomerulonephritis

Natsumi Kamijo, Akiko Mii, Sae Aratani, Tetsuya Kashiwagi, Takashi Oda, Akira Shimizu, Yukinao Sakai

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Keywords: ANCA-associated vasculitis, MPO-ANCA, neutrophil extra cellular trap, post-streptococcal acute glomerulonephritis, rapidly progressive glomerulonephritis

JOURNAL OPEN ACCESS Advance online publication

Article ID: 8690-21

DOI https://doi.org/10.2169/internalmedicine.8690-21

The final version of this article is now available: Vol. 61 (2022), No. 19 pp. 2917-2923

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Abstract

A 44-year-old woman was admitted due to gross hematuria and progressive renal dysfunction. Poststreptococcal acute glomerulonephritis (PSAGN) was suspected due to her elevated anti-streptolysin O and anti-streptokinase titers and hypocomplementemia. A renal biopsy showed crescent formation and endocapillary hypercellularity with neutrophil infiltrate. An immunofluorescence analysis showed granular immunoglobulin G and C3 deposition, suggesting immune-complex-type glomerulonephritis. However, myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA) was positive, and peritubular capillaritis was observed. Furthermore, citrullinated histone H3-positive neutrophils were detected as markers for neutrophil extracellular trap formation. Therefore, she was diagnosed with ANCA-associated vasculitis superimposed on PSAGN that was the main contributor to her progressive renal injury.

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