Rapidly progressive glomerulonephritis (RPGN) is a life-threatening disease characterized by rapid progressive deterioration of renal function and extensive formation of crescents. Some antibodies tend to be positive, such as a perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) and anti-glomerular basement membrane (anti-GBM) antibodies, in most patients with the disease. However, cases of double positivity for the above antibodies are considered to be rare. In addition, both rheumatoid arthritis (RA) and Sjogren’s syndrome (SS) are deemed to be independent immune disorders that can cause renal impairment. Nevertheless, the association between RPGN and these two diseases has not been elucidated in previous studies. Here, we provide a case of RPGN with the concurrence of RA and SS characterized by double positivity in anti-GBM antibodies and p-ANCA. After aggressive treatment with cyclophosphamide, glucocorticoids, and plasma exchange, the patient improved significantly. Despite the malignant event of arteriovenous fistula rupture and bleeding during treatment, the patient survived with renal function recovery for the rest of the follow-up period.
Background: This study investigated gut microbiota characteristics and their associations with lymphocyte subsets, cytokines, and disease activity in patients with ankylosing spondylitis (AS). Fecal DNA from 62 AS patients and 62 healthy controls (HCs) was subjected to 16S rRNA gene sequencing. The absolute numbers of peripheral lymphocyte subsets were detected by flow cytometry, while the serum levels of cytokines were tested by cytokine bead arrays. Results: The gut microbiota diversity was significantly decreased in AS patients, compared to HCs. Proteobacteria and Patescibacteria were more abundant in AS patients than in HCs; Firmicutes, Fusobacteriota, Verrucomicrobiota, Synergistota, and Campilobacterota were less abundant in AS patients than in HCs. At the genus level, the abundances of Escherichia–Shigella were increased in AS patients compared to HCs; in contrast, the abundances of Faecalibacterium, Prevotella, Agathobacter, Roseburia, and Dialister were decreased in AS patients. The linear discriminant analysis effect size indicated that Enterobacterales was the most significant order in AS patients. The relative abundances of Agathobacter, Ruminococcus, Prevotella, and CAG–352 were correlated with lymphocyte subsets and cytokine levels; the relative abundances of Faecalibacterium, Klebsiella, and Roseburia were correlated with disease activity. In addition, specific gut microbiota were significantly correlated with peripheral blood cell count, age, and body mass index. Conclusions: The gut microbiota in AS patients differed from the gut microbiota in HCs; changes in bacterial communities were associated with the immune profile that contributes to AS pathogenesis.
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