ANCA - Associated Vasculitis Case Study

Patient Story:

• 70 years old male
• Upon seeing the GP (On 01.05.20), the patient presented with persistent cough,  rash, and shortness of breath, and feeling unwell.
• Previous medical history: asthma, nose bleeds, recurrent, nasal congestion, fatigue and rash since October 2019. 
• Patient was referred to a respiratory consultant (as an outpatient) on the 14.05.20. 
• The patient was admitted to K hospital, with collapsed lung.
• Then transferred to another hospital as an inpatient on 21.05.20 with rapidly progressive pulmonary renal syndrome.
• On the 23.05.20 the patient began haemodialysis, given 3 pulses of IV methylprednisolone soon after and started on cyclophosphamide on 27.05.20.

GP Results:

Urea (2.5-7.0 mmol/L)	Creatinine (60-106 umol/L)	EGFR (>60 mL/min/1.73m2)	CRP (0-10 mg/L)
10.12.18: 5.4	67	>60
01.05.20 7.1	111	58	160
14.05.20 19.5	301	17	161
21.05.20 30.4	508	8	121

Immunology Results (on sample from 14.05.20): 

• IgE <2 kU/L (0-81)
• IgE aspergillus <0.35 kUA/L
• Aspergillus precipitins 10 mg/L (0-40)
• ANCA: C-ANCA pattern, MPO antibody negative, PR3 antibody 50 U/mL (0-2). 
• Anti-nuclear antibody negative 

Additional Immunology Results (on a sample from 22.05.20): 

• IgG = 12.9 g/L (6-16). 
• IgA = 1.5 g/L (0.2-4.0)
• IgM = 0.5 g/L (0.5-2.0)
• Protein electrophoresis: Low albumin, raised alpha-1 and alpha-2 globulins (with some zoning? - infection or inflammation).
• C3 = 1.0 g/L (0.75-1.65) 
• C4 = 0.22 g/L (0.14-0.54). 
• GBM antibody negative