The development of rapidly progressive glomerulonephritis associated with both antineutrophil cytoplasmic antibody-assoc
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BMC Rheumatology
CASE REPORT
Open Access
The development of rapidly progressive glomerulonephritis associated with both antineutrophil cytoplasmic antibodyassociated vasculitis and anti-glomerular basement membrane nephritis in the course of nontuberculous mycobacterium infection: a case report Mikiya Kato1* , Risa Wakiya1, Tomohiro Kameda1, Kousuke Inoue2, Tadashi Sofue3, Yusuke Ushio1, Koichi Sugihara1, Shusaku Nakashima1, Hiromi Shimada1, Mai Mahmoud Fahmy Mansour1, Norimitsu Kadowaki1 and Hiroaki Dobashi1
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. Keywords: Nontuberculous mycobacteriosis, Myeloperoxidase-antineutrophil cytoplasmic antibody, Anti-glomerular basement membrane antibody, Rapidly progressive glomerulonephritis * Correspondence: [email protected] 1 Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To vi
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