Case of MPO-ANCA-associated glomerulonephritis with acute pancreatitis, perforated duodenal ulcer and posterior reversible encephalopathy syndrome after steroid pulse therapy

Abstract

 We described the case of a 9-year-old girl with MPO-ANCA-associated glomerulonephritis, who developed acute pancreatitis, perforated duodenal ulcer and posterior reversible encephalopathy syndrome after steroid pulse therapy. She was suffering from mild proteinuria and hematuria. Laboratory examination showed a serum creatinin level of 0.71 mg/dl, and MPO-ANCA level of 198 EU. Renal biopsy revealed crescentic glomerulonephritis. On hospital day 8, we performed steroid pulse therapy on the patient with methylpredonisolone at 30mg/kg/day. On 2 days after the pulse therapy, she had abdominal pain with acute pancreatitis and we diagnosed her as having perforated duodenal ulcer on the basis of operative findings. On the next day she had a generalized seizure. We diagnosed her as having posterior reversible encephalopathy syndrome on the basis of head MRI findings. There is no report of children who developed acute pancreatitis with MPO-ANCA-associated glomerulonephritis, but are a few cases of adult who after steroid pulse therapy. We must take great care over another organs except kidney in case of MPO-ANCA-associated glomerulonephritis.