The development of rapidly progressive glomerulonephritis associated with both antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane nephritis in the course of nontuberculous mycobacterium infection: a case report

Abstract

Background Antineutrophil cytoplasmic antibodies (ANCA) and Anti-glomerular basement membrane (GBM) antibodies often induce rapidly progressive glomerulonephritis (RPGN). Some reports have demonstrated RPGN with the sequential appearance of ANCA then anti-GBM antibodies, suggesting that ANCA may induce the development of anti-GBM antibodies. Whereas, many reports have shown that the development of ANCA is associated with various infectious diseases, such as non-tuberculous mycobacterial infection. Case presentation A 65-year-old woman with pulmonary non-tuberculous mycobacterial (NTM) infection was monitored without treatment. One year later, serum myeloperoxidase (MPO)- ANCA were elevated (14.1 U/mL (normal value < 3.0 U/ml)). A high fever and RPGN appeared 1 year later, and serum MPO-ANCAs were 94.1 U/mL. Anti-GBM antibodies were also detected. A renal biopsy revealed crescentic glomerulonephritis with linear deposits of IgG and C3c along the GBM and interstitial inflammation with endarteritis of arterioles. The diagnosis was RPGN associated with anti-GBM nephritis and ANCA-associated vasculitis. Conclusion This report shows that preceding NTM infection may have induced ANCA and anti-GBM antibodies and caused the development of RPGN.

A Case of Eosinophilic Granulomatosis with Polyangiitis Combined with Pulmonary Tuberculosis: A Case Report

“…On the other hand, studies reports suggest that the development of ANCA is associated with Mycobacterium tuberculosis infection. One case report found that a patient with non-tuberculosis Mycobacterium infection developed ANCAassociated vasculitis after one year [14] . The studies indicated that NTM infection may induce ANCA.…”

Triple Jeopardy: Rapidly Progressive Glomerulonephritis Induced by Triple Seropositive Disease—A Rare Case

“…Double antibody-positive disease (DAPD), exhibiting antiglomerular basement (anti-GBM) and antineutrophil cytoplasmic antibodies (ANCAs) are auto-antibody mediated small vessel vasculitis with ideal preference to renal and pulmonary systems [ 5 ]. Several factors such as smoking, viral infection, or hydrocarbon compounds could precipitate this disease [ 5 , 6 ]. It is a variant of Goodpasture syndrome (GPS).…”

“…Anti-GBM disease is characterized by an autoimmune response against the α 3 chain of type IV collagen on the GBM in GPS [ 7 ]. Contrastingly, myeloperoxidase (MPO) and proteinase 3 (PR3) antibodies are features of ANCA-associated vasculitis (granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis) [ 5 ]. ANCA-associated vasculitis (AAV) can include the following features: purpura (granulomatous and nongranulomatous skin lesions), neuropathy, acute renal failure (due to neutrophil infiltration into renal tissue), hemoptysis (due to alveolar hemorrhage and nasopharyngeal/oropharyngeal tract hemorrhage), as well as more nonspecific features, such as arthralgias and fatigue.…”

“…ANCA-associated vasculitis (AAV) can include the following features: purpura (granulomatous and nongranulomatous skin lesions), neuropathy, acute renal failure (due to neutrophil infiltration into renal tissue), hemoptysis (due to alveolar hemorrhage and nasopharyngeal/oropharyngeal tract hemorrhage), as well as more nonspecific features, such as arthralgias and fatigue. Rapidly progressive glomerulonephritis with or without pulmonary involvement is an independent feature of either anti-GBM or ANCAs, making DAPD patients at risk of worsening renal outcomes [ 5 , 7 , 8 ].…”