| A 73-year-old man was admitted to the hospital because of progressive
lethargy and fever.
He had a history of hypertension since the age of 40, and was diagnosed
as having a testicular tumor at
the age of 50. On admission, he looked pale and stuporous. Laboratory examination
revealed microscopic
hematuria. The erythrocyte sedimentation rate was 110 mm/hr, and the serum
CRP was 14.3
mg/dl. The titer of myeloperoxidase-antineutrophilic cytoplasmic antibodies
(MPO-ANCA) was higher
than 1 : 1000. On the sixth hospital day, he required ventilatory assistance
because of aspiration pneumonia
and was connected to a respirator. He was treated with intravenous corticosteroids,
to which he
responded in the short term with resolution of the fever and decrease in
the serum CRP level, however,
the consciousness disturbance persisted and the fever recurred soon thereafter.
He developed gross
hematuria and the renal function deteriorated. He eventually died of renal
failure and pulmonary
hemorrhage. Although his clinical course and laboratory ?ndings were consistent
with those of microscopic
polyangitis, the pathological diagnosis was crescentic glomerulonephritis
with no evidence of
vasculitis. (Keio J Med 53 (2): 103?114, June 2004) |
