Microscopic polyangiitis presented with biopsy-confirmed pleuritis.

We describe a case of microscopic polyangiitis manifested as pleuritis confirmed by thoracoscopic biopsy. An 80-year-old man presented with a three-day history of shortness of breath and cough. Chest radiography revealed patchy opacities in the lower fields of the bilateral lung and right-sided pleural effusion. Thoracentesis revealed lymphocytic pleural exudates. Thoracoscopic biopsy specimens were compatible with fibrotic pleuritis. He developed rapidly progressive glomerulonephritis with elevated myeloperoxidase anti-neutrophil cytoplasmic antibody titer in blood and pleural effusion. Although the patient was resistant to two weekly courses of pulse steroid therapy, he was successfully treated with a five-day course of intravenous immunoglobulin.

[1]  C. Kallenberg,et al.  Pathogenesis of ANCA-associated vasculitis: new possibilities for intervention. , 2013, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[2]  V. Tesar,et al.  Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up , 2011, Annals of the rheumatic diseases.

[3]  Jonathan H. Chung,et al.  Common and uncommon manifestations of Wegener granulomatosis at chest CT: radiologic-pathologic correlation. , 2012, Radiographics : a review publication of the Radiological Society of North America, Inc.

[4]  P. Ind,et al.  Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study. , 2011, Rheumatology.

[5]  J. del Pino-Montes,et al.  Overall survival, renal survival and relapse in patients with microscopic polyangiitis: a systematic review of current evidence. , 2011, Rheumatology.

[6]  K. Chapman,et al.  The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights , 2011, Molecular and Cellular Endocrinology.

[7]  J. Janssen.  Why you do or do not need thoracoscopy , 2010, European Respiratory Review.

[8]  C. Ribi,et al.  Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors: A prospective randomized study of one hundred twenty-four patients. , 2010, Arthritis and rheumatism.

[9]  H. Sano,et al.  Microscopic polyangiitis accompanied by pleuritis as the only pulmonary manifestation of occupational silica exposure. , 2010, Internal medicine.

[10]  L. Mouthon,et al.  Intravenous immunoglobulins for relapses of systemic vasculitides associated with antineutrophil cytoplasmic autoantibodies: results of a multicenter, prospective, open-label study of twenty-two patients. , 2008, Arthritis and rheumatism.

[11]  M. Noppen,et al.  Does ‘Idiopathic Pleuritis’ Exist? Natural History of Non-Specific Pleuritis Diagnosed after Thoracoscopy , 2005, Respiration.

[12]  S. Kaveri,et al.  Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. , 2001, The New England journal of medicine.

[13]  L. Guillevin,et al.  Microscopic Polyangiitis with Alveolar Hemorrhage A Study of 29 Cases and Review of the Literature , 2000, Medicine.

[14]  K. Takahashi,et al.  [Microscopic polyangitis with pleuritis as the only pulmonary complication]. , 2000, Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society.

[15]  J. Amouroux,et al.  Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. , 1999, Arthritis and rheumatism.

[16]  F. Askin,et al.  The pathologic spectrum of pulmonary lesions in patients with anti-neutrophil cytoplasmic autoantibodies specific for anti-proteinase 3 and anti-myeloperoxidase. , 1995, American journal of clinical pathology.

[17]  R. Porter.  Nomenclature of Systemic Vasculitides: Proposal of an International Consensus Conference , 1995 .

[18]  Y. Arimura,et al.  [Pulmonary involvement in patients with myeloperoxidase specific-antineutrophil cytoplasmic antibody]. , 1995, Ryumachi. [Rheumatism].

[19]  U. Specks,et al.  Lesions of the respiratory tract associated with the finding of anti-neutrophil cytoplasmic autoantibodies with a perinuclear staining pattern. , 1994, Mayo Clinic proceedings.