Multiple renal infarctions in a patient caused by granulomatosis with polyangiitis

Abstract

Granulomatosis with polyangiitis (GPA) is a small-vessel vasculitis that is highly associated with anti-neutrophil cytoplasmic antibodies. GPA carries an increased risk of organ infarction, but renal infarction is rare. We herein describe a case of multiple renal infarctions caused by GPA. A 66-year-old man presented with hearing loss, nasal discharge, fatigue, and weight loss for several months. Cross-sectional contrast-enhanced computed tomography images revealed multiple low-attenuation areas in both kidneys. He subsequently developed fever and impaired renal function. Blood serum was positive for cytoplasmic anti-neutrophil cytoplasmic antibody and a renal biopsy showed granulomatous necrotizing vasculitis. He was diagnosed with GPA and treated with high-dose corticosteroids, plasma exchange, and cyclophosphamide. The patient ultimately entered clinical remission.

Renal Embolism Associated with Foramen Ovale Coexisting Acute Pulmonary Embolism

“…A thrombus through a PFO with impending paradoxical embolism is an extremely rare event [ 23 , 24 ]. Most renal infarctions are related to infective endocarditis, atrial fibrillation, and renal artery dissection [ 25 , 26 , 27 ]. This patient did not have the relevant diseases or any past history.…”

Granulomatosis With Polyangiitis Complicated by Diffuse Alveolar Hemorrhage, Splenic Infarction and Stroke

“…GPA can be complicated by renal infarction [1][2][3], and patients with active disease demonstrate altered indices of coagulation and fibrinolysis. This will lead to a hypercoagulable state that increases venous thromboembolic risk, which does not differ between MPO and PR3 vasculitis [4].…”