Antineutrophil Cytoplasmic Antibody-associated Vasculitis With Alveolar Hemorrhage and Ruptured Renal Aneurysm: a Case Report and Literature Review

Abstract

Background: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is characterized by necrotizing damage of small -vessel vasculitis and the main violation of the kidney or lung. Manifestation of alveolar hemorrhage and renal aneurysm is extremely rare in Granulomatosis with polyangiitis (GPA).Case presentation: A 50-year-old Chinese man was admitted due to repeated cough, expectoration, fever and shortness of breath. A chest computed tomography (CT) scan showed bilateral infiltrates in the lower lobe of the lung. GPA was considered based on the pulmonary capillaritis, alveolar hemorrhage, renal insufficiency and cANCA -PR3 positivity. Immunosuppressive therapy combined with plasma exchange (PE) was performed. The patient suffered from a rupture of renal aneurysm. Though selective renal arterial embolization was performed, the patient had a poor outcome. Conclusions: GPA could be life-threatening, especially large vessel vasculitis involved. The possibility of aneurysmal rupture should be carefully considered and checked frequently in the condition of immunosuppressive therapy.