Title:Case Report of MPO+ ANCA Vasculitis with Pauci-immune GN
Associated with Invasive Ductal Carcinoma of the Breast
Volume: 20
Issue: 2
Author(s): Biniyam Teka Mohammed*, Nnenna Uzodi, Ashwini Gotimukul and Rediet Kokebie
Affiliation:
- Department of Internal Medicine, Ascension St. Joseph Hospital, Chicago, Illinois, 60657, USA
Keywords:
ANCA vasculitis, paraneoplastic, MPO, pauci-immune, breast cancer, breast invasive ductal carcinoma.
Abstract:
Background: Malignancy-associated vasculitis usually presents in the form of polyarteritis
nodosa or leukocytoclastic vasculitis. However, ANCA vasculitis associated with malignancy
is rare. Here, we present a case of MPO+ ANCA vasculitis with pauci-immune GN associated
with invasive ductal carcinoma of the breast.
Case Presentation: A 66-year-old female with a history of rheumatoid arthritis, Hashimoto's thyroiditis,
and psoriasis presented with multiple joint pain, body aches, petechial rash, paresthesia
and numbness, and deranged renal function a month after diagnosis of localized left breast invasive
ductal carcinoma. Renal biopsy showed crescentic pauci-immune glomerulonephritis, and
serology was positive for Perinuclear Antineutrophil Cytoplasmic Antibody (P-ANCA) and
myeloperoxidase (MPO). The disease course was complicated by diverticulitis with peritonitis
and intraperitoneal abscess collection, which required laparoscopic peritoneal lavage and additional
interventional radiology-guided drainage of the abscess. We treated the patient successfully
with steroids, rituximab, and mastectomy for left breast malignant lesions, resulting in the resolution
of symptoms, normalization of inflammatory markers, and ANCA seroconversion.
Conclusion: Treating ANCA-associated Vasculitis (AAV) in surgical emergencies like bowel perforation
can be challenging. Individualized treatment strategy tailored to patients' acute needs is
crucial. In this case, we considered malignancy-associated vasculitis and pursued treatment that fit
the patient's clinical situation in a multidisciplinary approach.
