1990 Volume 21 Issue 1 Pages 107-114
A 72-year-old male with 35 years history of rheumatoid arthritis was admitted to our hospital because of the left leg ulcer. Depite of various treatments, the ulcer was not improved. After days of admission leg purpura and rapidly progressive glomerulonephritis with massive proteinuria developed. Although anticoagulant therapy was dose for his rapidly progressive glomerulonephritis, renal function declined rapidly in about two weeks. Hemodialysis was eventually instituted, but he died of massive intestinal hemorrhage. Postmortem histopathological examination of the kidney was performed and revealed mild mesangial proliferative glomerulonephritis with partial and circumferential crescent formation. Although vasculitis was not detected in his renal specimen, leg ulcer, purpura, subcutaneous nodules, intestinal hemorrhage, high titer of RAHA, low level of complements and positive anti-neutrophil cytoplasmic antibodies suggested the existence of vasculitis. We, therefore, thought that the rapidly progressive glomerulonehritis was probably related to vasculitis associated with rheumatoid arthritis. As far as we examined in the literatures, only 15 cases were reported on rheumatoid arthritis complicated by rapidly progressive glomerulonephritis, the pathogenesis of which was not considered related to drugs, amyloidosis or other collagen diseases. In these cases, 47 % was associated with the clinical signs of vasculitis, 20 % was detected to have vasculitis by histological examination. 42 % was required hemodialysis and 42 % was died. Although rapidly progressive glomerulonephritis is uncommon feature among extra-articular lesions of rheumatoid artrhitis, specific carefull attention should be made in patients with rheumatoid arthritis associated with vasculitis.
