SHM Converge Scientific Abstract ePoster Gallery-From Cap to Crisis: Anca-Associated Glomerulonephritis Teetering on the Brink of Demise

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A 55-year-old Caucasian man with no significant past medical history presented with several weeks of progressive dyspnea and pleuritic chest pain that did not improve with oral antibiotics. Initial imaging suggested atypical pneumonia, but his course rapidly worsened, revealing a more serious underlying process and demonstrating the danger of anchoring bias.<br /><br />On admission, he was found to have acute kidney injury with creatinine rising to 4.4 mg/dL from a baseline near 1.0 mg/dL one month earlier, along with severe microcytic anemia (hemoglobin 7.3 g/dL). These findings prompted concern for intrinsic renal disease and led to renal biopsy. Before the diagnosis was clear, he developed escalating hypoxic respiratory failure requiring intubation, mechanical ventilation, prone positioning, and ultimately ECMO, with concern for diffuse alveolar hemorrhage from a severe rheumatologic process.<br /><br />Renal biopsy showed diffuse crescentic glomerulonephritis with necrotizing lesions, consistent with pauci-immune PR3-ANCA–associated glomerulonephritis. He was treated aggressively with prednisone, cyclophosphamide, IVIG, plasma exchange, CRRT, ECMO, and Pneumocystis jirovecii pneumonia prophylaxis. He was successfully decannulated from ECMO five days later, cyclophosphamide was later discontinued, and he was discharged after a 39-day hospital stay.<br /><br />This case highlights how a presumed respiratory infection can mask a rapidly progressive, life-threatening vasculitic syndrome. It emphasizes the need to maintain a broad differential diagnosis, avoid premature closure, and pursue urgent multidisciplinary intervention when clinical clues point beyond routine pneumonia.

Asset Subtitle

Joshua Tsai

Meta Tag

Author List Danielle Madison, Hemantkumar Raval, Joshua Tsai, Walter Macedo

Category Clinical Vignettes

Concept ANCA-Associated Vasculitis

Concept Acute Glomerulonephritis

Concept Acute Kidney Injury

Concept Hypoxemic Respiratory Failure

Concept Pauci-Immune Crescentic Glomerulonephritis

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Joshua Tsai

Track Adult

Keywords

PR3-ANCA

pauci-immune glomerulonephritis

crescentic glomerulonephritis

diffuse alveolar hemorrhage

rapidly progressive vasculitis

acute kidney injury

microcytic anemia

ECMO

plasma exchange

anchoring bias

ANCA-Associated Vasculitis

Acute Glomerulonephritis

Acute Kidney Injury

Hypoxemic Respiratory Failure

Pauci-Immune Crescentic Glomerulonephritis