2020 Volume 53 Issue 6 Pages 339-344
The patient was an 87-year-old female. She was weak and suffered from limb numbness and vomiting. She was suspected of having cholangitis and was referred to our hospital. Emergency ERCP was performed, and antibiotic treatment was started. Her abdominal symptoms were ameliorated, but a fever and high CRP levels persisted. A blood test showed an increased MPO-ANCA level (1,545 U/mL), and microscopic polyangiitis was diagnosed. The patient’s renal function subsequently worsened, and intermittent hemodialysis was performed temporarily. Methylprednisolone and oral prednisolone were administered, followed by 7 rounds of plasma exchange and rituximab treatment, which resulted in dialysis no longer being required. The patient’s MPO-ANCA level decreased to 39.6 U/mL, and the associated organ damage, including renal problems, stabilized. This case involved an aged patient, who was diagnosed with ANCA-associated vasculitis caused by cholangitis. Remission was achieved with immunosuppressive therapy and plasma exchange.
