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Case report
Microscopic polyangiitis and antiphospholipid syndrome. An uncommon association
Poliangitis microscópica y síndrome antifosfolípido. Una asociación infrecuente
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Víctor Jaime López-Villegasa,b, Diego Alejandro Medina-Moralesa,b, Lina María Saldarriaga-Riveraa,c,d,
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vasculitisreumato@gmail.com

Corresponding author.
a Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
b Especialización en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
c Medicina Interna y Reumatología, Universidad Tecnológica de Pereira, Pereira, Colombia
d Departamento de Medicina Interna y Reumatología, Clínica Los Rosales, Pereira, Colombia
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Table 1. Results of paraclinical tests.
Abstract

Antiphospholipid syndrome is frequently associated with systemic lupus erythematosus and other autoimmune diseases. However, coexistence with primary vasculitis has been poorly reported. The case is presented of a 67-year-old patient with a history of recurrent abortion and chronic pulmonary thromboembolism who was admitted due to haemoptysis. At the initial evaluation, a massive alveolar haemorrhage and glomerulonephritis were diagnosed. The results of the antibodies were positive for ANCA with P-type pattern, anti-myeloperoxidase antibodies, and antiphospholipid antibodies (anti-β2 IgG glycoprotein 1 and lupus anticoagulant). Diagnosis of ANCA positive vasculitis-type microscopic polyangiitis was made in association with antiphospholipid syndrome. Given the clinical context, it was decided to initiate intravenous methylprednisolone in pulses for 3 consecutive days, followed by oral prednisone, and as maintenance therapy, rituximab and anticoagulation with warfarin were instituted. The clinical evolution of the patient was satisfactory, with symptom control being achieved, as well as a significant improvement of renal and pulmonary function, with a decrease in the Birmingham vasculitis activity score (BVAS).

Keywords:
Microscopic polyangiitis
Antiphospholipid syndrome
Vasculitis
Antineutrophil cytoplasmic antibody
Resumen

El síndrome antifosfolípido se asocia frecuentemente con lupus eritematoso sistémico y otras enfermedades autoinmunes. Sin embargo, la coexistencia con vasculitis primaria ha sido poco reportada. Se presenta el caso de una paciente de 67 años de edad con historia de aborto recurrente y tromboembolismo pulmonar crónico, quien es admitida para estudio de hemoptisis. A la evaluación inicial se diagnosticó una hemorragia alveolar masiva y glomerulonefritis. El resultado de los anticuerpos fue positivo para anticuerpos anticitoplasma de neutrófilos (ANCA) con patrón tipo perinuclear, anticuerpos anti-mieloperoxidasa y anticuerpos antifosfolípidos (anti β2 glicoproteína1 IgG y anticoagulante lúpico), configurándose el diagnóstico de vasculitis asociada a ANCA de tipo poliangitis microscópica en asociación con síndrome antifosfolípido. Dado el contexto clínico, se decidió iniciar metilprednisolona intravenosa en pulsos por 3días consecutivos, seguida de prednisona oral, y como terapia de mantenimiento se instauró rituximab y anticoagulación con warfarina. La evolución clínica de la paciente fue satisfactoria, alcanzando control de síntomas e importante mejoría de la función renal y pulmonar, con disminución del score BVAS.

Palabras clave:
Poliangitis microscópica
Síndrome antifosfolípido
Vasculitis
Anticuerpos anticitoplasma de neutrófilos

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