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- Haruyoshi Yoshida, Naoki Takahashi, Takayasu Horiguchi, Hiroki Yasuhara, Tokuharu Tanaka, Yuhao Chen, Toshikazu Takasaki, Hitokazu Tsukao, Michiko Yoshida, Satoshi Kawakami, Makoto Ohta, Hironobu Naiki, Satoshi Konishi, Isao Ito, and Masayuki Iwano.
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan.
- Intern. Med. 2021 Dec 15; 60 (24): 3927-3935.
AbstractA 78-year-old man presented with hypercalcemia and renal disease with high serum IgG4 and positive myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), exhibiting sarcoidosis-like chest findings. A renal biopsy revealed tubulointerstitial nephritis, membranous nephropathy (MN), and sub-capsular lymphoid aggregates without fulfilling the diagnostic criteria of IgG4-related disease or sarcoidosis. Steroid therapy ameliorated the serological and renal abnormalities. After 5 years, following gradual increases in the neutrophil count and upper respiratory infection (URI), necrotizing crescentic glomerulonephritis (NCGN) developed with an increased serum MPO-ANCA level. These results suggest that in the presence of MPO-ANCA in immune senescence, the persistent neutrophil increase with URI may lead to the development of NCGN.
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