Fatal pulmonary complication during induction therapy in a patient with ANCA-associated vasculitis

Brigita Jonaitytė,Jurgita Mitrikevičienė,Edvardas Danila,Dmitrij Šeinin,Rokas Stulpinas,Virginija Šileikienė,Vygantas Gruslys,Rūta Kibarskytė,Marius Miglinas,Rolandas Zablockis

doi:10.6001/actamedica.v23i2.3331

Brigita Jonaitytė, Jurgita Mitrikevičienė + Show 8 more

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https://doi.org/10.6001/actamedica.v23i2.3331

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ANCA-associated vasculitis (AAV) is an inflammatory systemic disorder affecting small to medium sized vessels and likely leading to any organ dysfunction. Adequate treatment is important to avoid mortality or severe organ damage. In most cases initial treatment (induction therapy) allows to achieve remission. Induction therapy leads to immunosuppression and may cause severe infections. However, in vasculitis patients even an intensive immunosuppressive therapy is rarely complicated by an invasive fungal infection.We present a case in a 29-year old male patient with newly diagnosed AAV. He suffered a fatal pulmonary complication of the induction immunosuppressive treatment. Pathological (infectious) changes in the lungs were misinterpreted as progression of the vasculitis and he died due to disseminated angioinvasive aspergillosis. A clinical course, imaging and histopathology of this case are described and discussed.

Highlights

We present a case in a 29-year old male patient with newly diagnosed associated vasculitis (AAV)
The anti-neutrophil cytoplasmic antibody (ANCA)associated vasculitis (AAV) is an inflammatory systemic disorder characterized by the production of ANCA [1]
In this article we present a case of AAV resulting in death, due to angioinvasive pulmonary Aspergillus infection

Summary

Nephrology Center of Vilnius University Hospital Santariškių Klinikos

ANCA-associated vasculitis (AAV) is an inflammatory systemic disorder affecting small to medium sized vessels and likely leading to any organ dysfunction. Adequate treatment is important to avoid mortality or severe organ damage. In most cases initial treatment (induction therapy) allows to achieve remission. Induction therapy leads to immunosuppression and may cause severe infections. In vasculitis patients even an intensive immunosuppressive therapy is rarely complicated by an invasive fungal infection. We present a case in a 29-year old male patient with newly diagnosed AAV. He suffered a fatal pulmonary complication of the induction immunosuppressive treatment. Pathological (infectious) changes in the lungs were misinterpreted as progression of the vasculitis and he died due to disseminated angioinvasive aspergillosis.

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