Uncommon onset manifestations without renal involvement in microscopic polyangiitis: A case report

Călinoiu,Amalia Loredana; Mincă,Dragoș Ionuț; Mincă,Alexandra; Popescu,Claudiu; Rusu,Adina; Gheorghiță,Valeriu; Dumitrașcu,Mihai; Mincă,Dana Galieta

doi:10.3892/etm.2022.11668

Uncommon onset manifestations without renal involvement in microscopic polyangiitis: A case report

Authors:
- Amalia Loredana Călinoiu
- Dragoș Ionuț Mincă
- Alexandra Mincă
- Claudiu Popescu
- Adina Rusu
- Valeriu Gheorghiță
- Mihai Dumitrașcu
- Dana Galieta Mincă
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Affiliations: Department of Internal Medicine, ‘Prof. Dr. Agrippa Ionescu’ Emergency Clinical Hospital, 011356 Bucharest, Romania, Center of Rheumatic Diseases ‘Dr. Ion Stoia’, 030167 Bucharest, Romania, Department of Public Health, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Infectious Diseases, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Obstetrics‑Gynecology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Published online on: October 24, 2022 https://doi.org/10.3892/etm.2022.11668
Article Number: 732
Copyright: © Călinoiu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Microscopic polyangiitis (MPA) is a rare, idiopathic, autoimmune, systemic disease that most frequently involves the kidneys. The present study reports the case of a 48‑year‑old female patient who presented with diffuse myalgia, arthralgia of both hands and feet for 2 weeks before being admitted to the hospital. The patient exhibited involuntary loss of weight and occasional slight fever. Physical examination noted microstomia and perioral radial furrows, slight skin induration of the hands, discrete cyanotic skin areas on the dorsal side of both feet. The patient also presented bilateral crepitant rales. Laboratory findings at admission revealed non‑specific biological inflammatory syndrome consisting of high erythrocyte sedimentation rate and high C‑reactive protein. The patient was initially suspected of systemic sclerosis due to the appearance of microstomia and the slight skin induration of the hands with diffuse arthralgia and myalgia, although with negative immune tests (anti‑SCL70 and anti‑centromere B antibodies) and normal nailfold capillaroscopy. Instead, a high titer of MPO‑ANCA was detected. The computerized tomography scan revealed early diffuse interstitial lung disease (ILD). Cases of MPA with pulmonary involvement, such as ILD before the onset of vasculitis or kidney involvement, are known. Therefore, the diagnosis of MPA was formulated considering the symptoms, the clinical examination and the high titer of MPO‑ANCA. The particularity of the present case consists in the uncommon onset with atypical skin changes, positivity to MPO‑ANCA, absent renal dysfunction and ILD involvement.

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