ABSTRACT
Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis, primarily associated with rapidly progressive glomerulonephritis and alveolar hemorrhage. Approximately 50% of MPA cases are associated with gastrointestinal involvement, but rarely do cases involve the gall bladder. We report an unusual case of MPA complicated by hemocholecystitis. A 62-year-old woman was admitted to our hospital with rapidly progressive renal dysfunction and pneumonia unresponsive to antibiotics. A chest CT scan showed bilateral diffuse alveolar consolidation, and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) staining was positive. During the course of hospitalization, the patient complained of severe abdominal pain, and an abdominal CT scan revealed acalculous cholecystitis with hemorrhage. Cholecystectomy was performed, and a gall bladder biopsy revealed fibrinoid necrosis of small arteries without granuloma. Cholecystitis should be considered in patients with unexplained upper abdominal pain and MPA.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Acalculous Cholecystitis , Anti-Bacterial Agents , Antibodies, Antineutrophil Cytoplasmic , Arteries , Biopsy , Cholecystectomy , Cholecystitis , Glomerulonephritis , Granuloma , Hemorrhage , Hospitalization , Microscopic Polyangiitis , Necrosis , Pneumonia , Thorax , Urinary Bladder , VasculitisABSTRACT
Microcopic polyangiitis (MPA) is a systemic disorder affecting small vessels. In MPA, the central nervous system involvements have rarely been reported. We experienced a case of MPA with subdural effusion and pachymeningitis in a 50-year-old woman. The diagnosis of MPA was made by the presence of mononeuritis multiplex, hematuria, pachymeningitis, and p-ANCA seropositivity in this patient. Subdural effusion was of exudates and an active suppurative inflammation was observed on the dural biopsy.