Abstract
Background. ANCA-associated systemic vasculitis is a rare childhood disease. Antineutrophil cytoplasmic autoantibodies (ANCA)-related vasculitises include microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. Their rarity often leads to a late diagnosis, rapid disability and high mortality in patients due to aggressive respiratory, pulmonary lesion and renal failure.Clinical Case Description. The patient suffered from a recurrent bronchoobstructive syndrome with signs of respiratory failure, obscure origin fever and chronic rhinitis with nasal bleeding for 6 months. The patient was diagnosed with obstructive bronchitis (putative bronchial asthma debut), received antibacterial therapy and inhalation bronchodilators without stable improvement during the entire period. Skin haemorrhages and arthralgia stimulated diagnostic research to establish ANCA-associated systemic vasculitis (presence of proteinase 3-specifi c ANCAs in titre 1/80). CT lung scanning revealed frosted glass foci of reduced pulmonary pneumatisation and signs of bilateral bronchoobstruction. Immunosuppressive therapy with glucocorticosteroids (methylprednisolone pulse therapy No. 3, 1000 mg intravenously on alternate days, subsequent per os administration of 1 mg/kg/day) and cyclophosphamide (500 mg intravenously once per 28 days) was prescribed. This led to the positive dynamics with eliminated fever and skin haemorrhages, as well as essentially reduced signs of respiratory failure.Conclusion. Diagnosis of systemic vasculitis is often complicated and long-term due to commonly non-specifi c debut symptoms of autoimmune disorders. In the described case, the fi rst 6 months of illness displayed intoxication and bronchoobstruction with signs of respiratory failure. Haemorrhagic rashes, arthralgias and the presence of ANCAs are proxy to vasculitis. Standard immunosuppressive therapy for ANCA-associated vasculitis improved the patient’s condition.
Highlights
Antineutrophil cytoplasmic autoantibodies (ANCA)-associated systemic vasculitis is a rare childhood disease
Their rarity often leads to a late diagnosis
The patient suffered from a recurrent bronchoobstructive syndrome with signs
Summary
Diagnosis of systemic vasculitis is often complicated and long-term due to commonly non-specific debut symptoms of autoimmune disorders. Haemorrhagic rashes, arthralgias and the presence of ANCAs are proxy to vasculitis. Standard immunosuppressive therapy for ANCA-associated vasculitis improved the patient’s condition. For citation: Burlutskaya A.V., Savelyeva N.V., Taran N.S. ANCA-associated vasculitis in a 14 years-old patient: a clinical case. Системные васкулиты (СВ) — достаточно редкая группа болезней в детском возрасте, и характеризуются они возникновением воспаления в стенке кровеносных сосудов разного калибра, приводящего к ишемии и некрозу тканей. Для удобства диагностического поиска в клинической практике все СВ разделены на три группы (в зависимости от калибра пораженного сосуда): васкулиты мелких, средних и крупных сосудов. ANCA (АНЦА) — это антинейтрофильные цитоплазматические аутоантитела. В детском возрасте очень редко встречаются ANCA-ассоциированные СВ. Согласно современному определению ГПА — это гигантоклеточный гранулематозно-некротизирующий васкулит, ассоциированный с выработкой ANCA и характеризующийся сочетанным воспалительным.
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