Hemoptysis Revealing Microscopic Polyangiitis: A Case Report

TL;DR

A 63-year-old man with hemoptysis and kidney issues was diagnosed with microscopic polyangiitis, a rare vasculitis, and treated with immunosuppressive therapy.

Contribution

This case report highlights MPA as a potential cause of unexplained pulmonary and renal symptoms with positive ANCA serology.

Findings

The patient presented with hemoptysis, dyspnea, and constitutional symptoms, leading to the diagnosis of MPA.

Positive anti-MPO p-ANCA and renal impairment supported the MPA diagnosis.

Treatment with corticosteroids and cyclophosphamide was adjusted based on renal function.

Abstract

Microscopic polyangiitis (MPA) is a rare, necrotizing vasculitis affecting small-caliber vessels, commonly associated with anti-neutrophil cytoplasmic antibodies (ANCA), particularly anti-myeloperoxidase (MPO). We report the case of a 63-year-old male with a medical history of chronic smoking and hypothyroidism, who presented with hemoptysis, worsening dyspnea, and constitutional symptoms. Imaging revealed bilateral alveolo-interstitial infiltrates indicative of lung involvement, along with a distal pulmonary embolism. Laboratory investigations found anemia, rapidly progressive renal impairment, and positive anti-MPO perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) at high titers, supporting a diagnosis of MPA. The patient was treated with high-dose corticosteroids and cyclophosphamide, with the immunosuppressive therapy adjusted according to his renal function. This case highlights the importance of considering MPA in patients with unexplained pulmonary and renal manifestations, especially in the presence of constitutional symptoms and positive ANCA serology.

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