SHM Converge Scientific Abstract ePoster Gallery-Mycobacterium Abscessus: An Unconventional Culprit of Anca Associated Vasculitis

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This case describes a 79-year-old woman with chronic bronchiectasis on home oxygen who presented with worsening shortness of breath and acute kidney injury. Her creatinine rose from a baseline of 0.85 mg/dL to 2.2 mg/dL, and urinalysis showed proteinuria, pyuria, hematuria, and bacteria, along with new anemia. Because of active urinary sediment, pulmonary decline, and anemia, clinicians evaluated for infectious glomerulonephritis versus ANCA-associated vasculitis (AAV). ANCA testing was positive for MPO and PR3 antibodies. EGD excluded gastrointestinal bleeding.<br /><br />She was treated initially with IV steroids and empiric antibiotics while respiratory cultures grew Mycobacterium abscessus complex (MABC), a nontuberculous mycobacterium associated with underlying lung disease such as bronchiectasis. Her renal biopsy confirmed crescentic glomerulonephritis consistent with AAV. She then received rituximab and prednisone for vasculitis, while also being treated for MABC with inhaled amikacin, clofazimine, and later omadocycline after insurance approval.<br /><br />Despite treatment, she returned two months after discharge with worsening dyspnea and failure to thrive and chose comfort-focused care.<br /><br />The case highlights a rare association between MABC infection and AAV, particularly in patients with chronic bronchiectasis. It underscores the challenge of managing simultaneous infection and autoimmune vasculitis, where immunosuppression is needed to control AAV but may worsen mycobacterial disease. The authors suggest that chronic or excessive immune activation from NTM infection may contribute to ANCA formation and vascular injury.

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Matthew Knapp

Meta Tag

Author List Kashish Kainth, Mahija Cheekati, Matthew Knapp, Shivangi Patel, Sindhupavani Avuthu

Category Clinical Vignettes

Concept Mycobacterium abscessus complex

Concept ANCA-Associated Vasculitis

Concept Antineutrophil cytoplasmic antibody

Concept Crescentic glomerulonephritis

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization Atlantic Health

Presenting Author Matthew Knapp

Track Adult

Keywords

bronchiectasis

acute kidney injury

ANCA-associated vasculitis

crescentic glomerulonephritis

Mycobacterium abscessus complex

nontuberculous mycobacteria

MPO-ANCA

PR3-ANCA

rituximab

immunosuppression

Mycobacterium abscessus complex

ANCA-Associated Vasculitis

Antineutrophil cytoplasmic antibody

Crescentic glomerulonephritis

Immunosuppression