Аннотация:A 72-year-old woman was admitted for rapidly progressive glomerulonephritis.Three years previously, she was diagnosed with interstitial lung disease at another hospital.At that time, a dipstick test showed hematuria (1þ) and proteinuria (-), but she tested negative for myeloperoxidase anti-neutrophilic cytoplasmic antibodies (MPO-ANCA)( < 1.0 U/mL; normal, < 3.5 U/mL).As respiratory symptoms were absent, she was followed-up with chest radiography.Ten months previously, she developed polyarthralgia and was diagnosed with rheumatoid arthritis following a positive result for rheumatoid factor.Testing for MPO-ANCA was again ordered, and showed positive conversion at 9.0 U/mL.Therapy with tacrolimus and celecoxib alleviated her symptoms.Her medical history included cholecystectomy and lumbar compression fracture, and her medication regime comprised tacrolimus, celecoxib, famotidine, and sulfamethoxazole/ trimethoprim.Laboratory tests indicated acute renal failure with active urinary sediment: BUN, 42.2 mg/dL; creatinine, 4.23 mg/dL; urinary protein, 2þ; and urinary erythrocytes, > 300/high-power field.The level of MPO-ANCA was highly elevated at 71.2 U/mL.Renal biopsy showed necrotizing crescentic glomerulonephritis.Our experience indicates that interstitial lung disease may be a cause, rather than a result, of ANCA-associated vasculitis.
