Looks can be Deceiving: A Challenging Case of Anti-Neutrophil Cytoplasmic Autoantibody Associated Vasculitis

Bashar Ramadan,Eric K Magliulo,Khalid Bashir,Moeed Ahmed,Jocelyn Taylor

doi:10.7759/cureus.15906

Abstract

[Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis] (AAV) is an autoimmune disease characterized by systemic vascular inflammation. We present a case of a 76-year-old man who presented with shortness of breath, fatigue, and weakness. He was eventually diagnosed with hydralazine-induced ANCA-associated renal limited glomerulonephritis. The presentation of this case was unique for a few reasons; the patient showed an initial improvement in kidney function, was non-oliguric, and had no systemic signs of vasculitis. This led to the patient being discharged prematurely with the diagnosis of acute tubular necrosis. We discuss educational features of this case and warn future clinicians about the possibility of waxing and waning renal function in these patients, as well as the importance of having a higher index of suspicion for glomerulonephritis in patients who take hydralazine.

Highlights

[Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis] (AAV) is an autoimmune disease characterized by systemic vascular inflammation
We present a case of a 76-year-old man who presented with shortness of breath, fatigue, and weakness. He was eventually diagnosed with hydralazine-induced ANCA-associated renal limited glomerulonephritis. The presentation of this case was unique for a few reasons; the patient showed an initial improvement in kidney function, was non-oliguric, and had no systemic signs of vasculitis
We present a unique case of renal limited glomerulonephritis likely caused by hydralazine-induced AAV

Summary

Introduction

[Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis] (AAV) is an autoimmune disease characterized by systemic vascular inflammation. We present a unique case of renal limited glomerulonephritis likely caused by hydralazine-induced AAV This case demonstrates that some expected clinical features may not always be present, and this can lead to a possible delay in diagnosis as well as a potential increase in morbidity for these patients. This is a case of a 76-year-old Caucasian man with a known past medical history of chronic kidney disease stage IIIb and hypertension, who had been taking hydralazine, losartan, and hydrochlorothiazide for several years.

Discussion

Conclusions

Disclosures

Couser WG

Hoffman GS