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Antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding.

Kim M, Kim YU, Boo SJ, Kim SM, Kim HW - Kidney Res Clin Pract (2015)

Bottom Line: On the 45(th) hospital day, the patient suddenly lost consciousness.Brain computed tomography showed intracerebral hemorrhage.We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

ABSTRACT
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45(th) hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

No MeSH data available.


Related in: MedlinePlus

Superior mesenteric angiography of the patient. Selective superior mesenteric arteriography reveals an active contrast extravasation in a branch of the distal ileal artery (arrow).
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f0015: Superior mesenteric angiography of the patient. Selective superior mesenteric arteriography reveals an active contrast extravasation in a branch of the distal ileal artery (arrow).

Mentions: On the 15th hospital day, massive hematochezia occurred, and hemoglobin levels decreased from 9.2 mg/dL to 6.4 g/dL within 24 hours (Fig. 2). Initial resuscitation was conducted using a crystalloid solution and packed RBC transfusion. Although emergency gastroscopy and colonoscopy were performed, the bleeding focus was not detected, but a large amount of old blood was observed in the terminal ileum. After 2 days, a colonoscopy was performed again, but abnormal findings associated with bleeding were not detected. Then, a capsule endoscopy was attempted to determine if the bleeding focus was located in the small bowel. However, owing to a slow small bowel transit time, the entire small bowel could not be observed because the capsule did not reach the mid-to-distal ileum. On the 22nd hospital day, recurrent massive hematochezia occurred. Abdominal computed tomography angiography showed active arterial bleeding on the ileal loop, and selective superior mesenteric arteriography revealed an active contrast extravasation in a branch of the distal ileal artery (Fig. 3). We selectively performed embolization with a permanent embolic agent (n-butyl cyanoacrylate; 0.5 mL tissue adhesive, 1.5 mL ethionidized oil mixture), and the bleeding stopped.


Antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding.

Kim M, Kim YU, Boo SJ, Kim SM, Kim HW - Kidney Res Clin Pract (2015)

Superior mesenteric angiography of the patient. Selective superior mesenteric arteriography reveals an active contrast extravasation in a branch of the distal ileal artery (arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608877&req=5

f0015: Superior mesenteric angiography of the patient. Selective superior mesenteric arteriography reveals an active contrast extravasation in a branch of the distal ileal artery (arrow).
Mentions: On the 15th hospital day, massive hematochezia occurred, and hemoglobin levels decreased from 9.2 mg/dL to 6.4 g/dL within 24 hours (Fig. 2). Initial resuscitation was conducted using a crystalloid solution and packed RBC transfusion. Although emergency gastroscopy and colonoscopy were performed, the bleeding focus was not detected, but a large amount of old blood was observed in the terminal ileum. After 2 days, a colonoscopy was performed again, but abnormal findings associated with bleeding were not detected. Then, a capsule endoscopy was attempted to determine if the bleeding focus was located in the small bowel. However, owing to a slow small bowel transit time, the entire small bowel could not be observed because the capsule did not reach the mid-to-distal ileum. On the 22nd hospital day, recurrent massive hematochezia occurred. Abdominal computed tomography angiography showed active arterial bleeding on the ileal loop, and selective superior mesenteric arteriography revealed an active contrast extravasation in a branch of the distal ileal artery (Fig. 3). We selectively performed embolization with a permanent embolic agent (n-butyl cyanoacrylate; 0.5 mL tissue adhesive, 1.5 mL ethionidized oil mixture), and the bleeding stopped.

Bottom Line: On the 45(th) hospital day, the patient suddenly lost consciousness.Brain computed tomography showed intracerebral hemorrhage.We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

ABSTRACT
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45(th) hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

No MeSH data available.


Related in: MedlinePlus