RESUMO
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.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Dor Abdominal , Colecistite Acalculosa , Antibacterianos , Anticorpos Anticitoplasma de Neutrófilos , Artérias , Biópsia , Colecistectomia , Colecistite , Glomerulonefrite , Granuloma , Hemorragia , Hospitalização , Poliangiite Microscópica , Necrose , Pneumonia , Tórax , Bexiga Urinária , VasculiteRESUMO
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.