2026 Volume 59 Issue 2 Pages 48-54
A 71‒year‒old man initially presented in 2013, at the age of 63, with hematuria, proteinuria, and declining renal function. He was diagnosed with rapidly progressive glomerulonephritis secondary to ANCA‒associated vasculitis, and was treated with corticosteroids. Despite this therapy, his renal function gradually deteriorated, leading to the initiation of maintenance hemodialysis at the age of 65. Prednisolone was tapered and discontinued at age 66, after which he received annual maintenance therapy with rituximab until the age of 69. From 69 years old onward, his MPO‒ANCA titers remained persistently elevated (100‒500 IU/mL)；however, he exhibited no systemic manifestations of vasculitis, and immunosuppressive therapy was withheld while he was monitored closely. In May 2023, the patient presented to the emergency department with hemoptysis. Chest computed tomography revealed an infiltrative shadow in the right lung, and he was diagnosed with alveolar hemorrhage secondary to ANCA‒associated vasculitis. He was consequently admitted and received re‒induction therapy with high‒dose corticosteroid pulse therapy and rituximab, resulting in clinical improvement. Subsequently, he was discharged on hospital day 24. Although elevated MPO‒ANCA levels have been reported to be associated with an increased risk of relapse, no standardized treatment strategies incorporating MPO‒ANCA titers have been established. With the advent of maintenance hemodialysis, renal lesions are no longer a reliable indicator of disease activity； therefore, meticulous monitoring of systemic symptoms is essential.
