SHM Converge Scientific Abstract ePoster Gallery-Microscopic Polyangiitis (Mpa) Presenting as Interstitial Lung Disease (Ild) : Case Report

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A 62-year-old man with a heavy smoking history and occupational exposure to fumes and dust presented with worsening dyspnea and chronic cough despite treatment for COPD. A low-dose chest CT incidentally found interstitial lung disease, and repeat imaging showed progressive lower-lobe fibrosis with honeycombing and traction bronchiectasis, consistent with a usual interstitial pneumonia (UIP) pattern. He was clinically stable on examination, with no acute respiratory distress and normal systemic findings. Although he had a history of GERD, it was well controlled and unlikely to explain the lung disease.<br /><br />Because the radiologic pattern could represent idiopathic pulmonary fibrosis (IPF) or another cause of fibrotic ILD, a secondary workup was performed, including autoimmune testing. This revealed positive P-ANCA and myeloperoxidase (MPO) antibodies, along with elevated ESR and CRP, leading to the diagnosis of microscopic polyangiitis (MPA)-associated ILD.<br /><br />The case highlights an important diagnostic challenge: MPA can present with slowly progressive fibrotic lung disease that closely mimics IPF, especially in older adults. While MPA more commonly causes renal involvement or acute pulmonary manifestations such as diffuse alveolar hemorrhage, it can also present as UIP-pattern ILD. Differentiating MPA-ILD from IPF is critical because treatment differs substantially. Unlike IPF, which is mainly managed supportively, MPA may respond to immunosuppressive therapy, which can slow or halt progression. The report emphasizes the importance of routine ANCA/MPO testing in unexplained ILD to enable early diagnosis and appropriate treatment.

Asset Subtitle

Pankil Thaker

Meta Tag

Author List Chinmay Atulkumar Patel, Meet Ashokbhai Ghonia, Pankil Thaker, Saketh Shekar, Tarun Parvataneni, Urvish Patel

Category Clinical Vignettes

Concept Microscopic Polyangiitis

Concept Interstitial Lung Disease

Concept Usual Interstitial Pneumonia

Concept MPO-ANCA

Concept Idiopathic Pulmonary Fibrosis

Distinguished Non-Finalist

Presenter Organization Narendra Modi Medical College, Ahmedabad, Gujarat, India.

Presenting Author Pankil Thaker

Track Adult

Keywords

microscopic polyangiitis

interstitial lung disease

usual interstitial pneumonia

MPO antibodies

P-ANCA

idiopathic pulmonary fibrosis

fibrotic ILD

honeycombing

traction bronchiectasis

immunosuppressive therapy

Microscopic Polyangiitis

Interstitial Lung Disease

Usual Interstitial Pneumonia

MPO-ANCA

Idiopathic Pulmonary Fibrosis