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
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