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Inicio Revista Colombiana de Reumatología Poliangiítis microscópica: reporte de un caso con enfermedad renal, pulmonar y...
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Vol. 18. Núm. 2.
Páginas 121-134 (Junio 2011)
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Vol. 18. Núm. 2.
Páginas 121-134 (Junio 2011)
Acceso a texto completo
Poliangiítis microscópica: reporte de un caso con enfermedad renal, pulmonar y neurológica, y revisión de la literatura
Microscopic Polyangiitis: a case report with renal, pulmonary and neurological involvement and review of the literature
Visitas
3238
Carolina Muñoz Grajales1, Álvaro Arbeláez Cortés1, Luis Fernando Arias Restrepo2, Mauricio Restrepo Escobar3, Luis Alonso González Naranjo3,
Autor para correspondencia
lagnvvn@hotmail.com

Correspondencia.
1 Residentes Reumatología, Universidad de Antioquia
2 Profesor, Departamento de Patología, Facultad de Medicina, Universidad de Antioquia
3 Profesor, Departamento de Medicina Interna, Sección de Reumatología, Facultad de Medicina, Universidad de Antioquia
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Resumen

Informamos el caso de un hombre de 79 años con hemorragia alveolar, glomerulonefritis necrosante y polineuropatía por poliangiítis microscópica, una enfermedad autoinmune, caracterizada por vasculitis sistémica, predominantemente de vasos de pequeño calibre. Se revisan los aspectos clínicos y terapéuticos de la enfermedad.

Palabras clave:
poliangiítis microscópica
autoanticuerpos contra el citoplasma de neutrófilos (ANCA)
hemorragia alveolar
glomerulonefritis necrosante
Summary

We report the case of a 79 years-old male, with alveolar hemorrhage, necrotizing glomerulonephritis and polyneuropathy due to microscopic polyangiitis, an autoimmune disease, characterized by systemic vasculitis, predominantly of small vessels. We review the clinical and therapeutic aspects of the disease.

Key words:
microscopic polyangiitis
antineutrophil cytoplasmic autoantibodies (ANCA)
alveolar hemorrhage
necrotizing glomerulonephritis
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Referencias
[1.]
D.G.I. Scott, R. Watts.
Polyarteritis nodosa and microscopic polyangiitis.
Rheumatology, 4th, pp. 1511-1519
[2.]
F. Wohlwill.
Uber die nur Mikroskopich erkenbarre From der Periarteritis nodosa.
Arch Pathol Anat, 246 (1923), pp. 377-411
[3.]
J. Davson, J. Ball, R. Plat.
The kidney in periarteritis nodosa.
Q J Med, 67 (1948), pp. 175-202
[4.]
J. Janette, R.J. Falk, K. Andrassy, P.A. Bacon, J. Churg, W.L. Gross, et al.
Nomenclature of systemic vasculitis. Proposal of an international consensus conference.
Arthrirtis Rheum, 37 (1994), pp. 187-192
[5.]
D.J. Davies, J.E. Moran, J.F. Nial, G.B. Ryan.
Segmental necrotising glomerulonephritis with antineutrophil antibody: posible arbovirus aetiology?.
Br Med J, 285 (1982), pp. 606
[6.]
F.J. van der Woude, N. Rasmussen, S. Lobatto, A. Wiik, H. Permin, L.A. van Es, et al.
Autoantibodies against neutrophils and monocytes tool for diagnosis and marker of disease activity in Wegener's granulomatosis.
Lancet, 1 (1985), pp. 425-429
[7.]
R.J. Falk, J.C. Janette.
Anti-neutrophil cytoplasmic autoantibodies with specificity for myeloperoxidase in patients with systemic vasculitis and idiopathic necrotizing and crescentic glomerulonephritis.
N Engl J Med, 318 (1988), pp. 1651-1657
[8.]
J.C. Jennette, R.J. Falk.
Anti-neutrophil cytoplasmic autoantibodies and associated diseases: a review.
Am J Kidney Dis, 15 (1990), pp. 517-529
[9.]
R. Goldschmeding, K.M. Dolman, M.E. van den Ende, C.H. van der Meer-Gerritsen, A. Sonnenberg, A.E. dem Borne.
The relation of 29 kD C-ANCA antigen to proteinase 3.
APMIS Suppl, 19 (1990), pp. 26-27
[10.]
L. Smyth, G. Gaskin, C.D. Pusey.
Microscopic polyangiitis.
Semin Respir Crit Care Med, 25 (2004), pp. 523-533
[11.]
R.J. Falk, P.H. Nachman, S.L. Hogan, J.C. Jennette.
ANCA glomerulonephritis and vasculitis: a Chapel Hill perspective.
Semin Nephrol, 20 (2000), pp. 233-243
[12.]
S.A. Chung, P. Seo.
Microscopic polyangiitis.
Rheum Dis Clin North Am, 36 (2010), pp. 545-558
[13.]
E. Ntatsaki, R.A. Watts, D.G. Scott.
Epidemiology of ANCA-associated vasculitis.
Rheum Dis Clin North Am, 36 (2010), pp. 447-461
[14.]
M. Andrews, M. Edmunds, A. Campbell, J. Walls, J. Feehally.
Systemic vasculitis in the 1980's – is there an increasing incidence of Wegener's granulomatosis and microscopic polyarteritis?.
J R Coll Physicians Lond, 24 (1990), pp. 284-288
[15.]
M.A. González-Gay, C. García-Porrúa.
Systemic vasculitis in adults in northwestern Spain 1988-97. Clinical and epidemiological aspects.
Medicine (Baltimore), 78 (1999), pp. 292-308
[16.]
R.A. Watts, M.A. González-Gay, S.E. Lane, C. Garcia-Porrúa, G. Bentham, D.G. Scott.
Geoepidemiology of systemic vasculitis.
Ann Rheum Dis, 60 (2001), pp. 170-172
[17.]
S.E. Lane, R.A. Watts, G. Bentham, N.J. Innes, D.G. Scott.
Are environmental factors important in primary systemic vasculitis?. A case-control study.
Arthritis Rheum, 48 (2003), pp. 814-823
[18.]
J. Flint, M.D. Morgan, C.O. Savage.
Pathogenesis of ANCA-associated vasculitis.
Rheum Dis Clin North Am, 36 (2010), pp. 463-477
[19.]
H. Xiao, P. Heeringa, P. Hu, Z. Liu, M. Zhao, Y. Aratani, et al.
Antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase cause glomerulonephritis and vasculitis in mice.
J Clin Invest, 110 (2002), pp. 955-963
[20.]
J.U. Holle, W.L. Gross.
ANCA-associated vasculitides: pathogenetic aspects and current evidence-based therapy.
J Autoimmun, 32 (2009), pp. 163-171
[21.]
P.M. Villiger, L. Guillevin.
Microscopic polyangiitis: Clinical presentation.
Autoimmun Rev, 9 (2010), pp. 812-819
[22.]
L. Guillevin, B. Durand-Gasselin, R. Cevallos, M. Gayraud, F. Lhote, P. Callard, et al.
Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients.
[23.]
C.O. Savage, C.G. Winearls, D.J. Evans, A.J. Rees, C.M. Lockwood.
Microscopic polyarteritis: presentation, pathology and prognosis.
Q J Med, 56 (1985), pp. 467-483
[24.]
H.A. Hauer, I.M. Bajema, H.C. van Houwelingen, F. Ferrario, L.H. Noël, R. Waldherr, et al.
Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups.
[25.]
J.B. Levy, T. Hammad, A. Coulthart, T. Dougan, C.D. Pusey.
Clinical features and outcome of patients with both ANCA and anti-GBM antibodies.
Kidney Int, 66 (2004), pp. 1535-1540
[26.]
C.E. Collins, F.P. Quismorio Jr..
Pulmonary involvement in microscopic polyangiitis.
Curr Opin Pulm Med, 11 (2005), pp. 447-451
[27.]
D. Lauque, J. Cadranel, R. Lazor, J. Pourrat, P. Ronco, L. Guillevin, et al.
Microscopic polyangiitis with alveolar hemorrhage. A study of 29 cases and review of the literature. Groupe d’Etudes et de Recherche sur les Maladies “Orphelines” Pulmonaires (GERM“O”P).
Medicine (Baltimore), 79 (2000), pp. 222-233
[28.]
T. Kawakami, Y. Soma, C. Saito, H. Ogawa, Y. Nagahuchi, T. Okazaki, et al.
Cutaneous manifestations in patients with microscopic polyangiitis: two case reports and a minireview.
Acta Derm Venereol, 86 (2006), pp. 144-147
[29.]
N. Kluger, C. Pagnoux, L. Guillevin, C. Francès, French Vasculitis Study Group.
Comparison of cutaneous manifestations in systemic polyarteritis nodosa and microscopic polyangiitis.
Br J Dermatol, 159 (2008), pp. 615-620
[30.]
N. Hattori, K. Mori, K. Misu, H. Koike, M. Ichimura, G. Sobue.
Mortality and morbidity in peripheral neuropathy associated Churg-Strauss syndrome and microscopic polyangiitis.
J Rheumatol, 29 (2002), pp. 1408-1414
[31.]
Y. Furukawa, Y. Matsumoto, M. Yamada.
Hypertrophic pachymeningitis as an initial and cardinal manifestation of microscopic polyangiitis.
Neurology, 63 (2004), pp. 1722-1724
[32.]
B.D. Ku, H.Y. Shin.
Multiple bilateral non-hemorrhagic cerebral infarctions associated with microscopic polyangiitis.
Clin Neurol Neurosurg, 111 (2009), pp. 904-906
[33.]
C. Pagnoux, A. Mahr, P. Cohen, L. Guillevin.
Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis. Wegener granulomatosis, Churg- Strauss syndrome, or rheumatoid arthritis-associated vasculitis.
Medicine, 84 (2005), pp. 115-128
[34.]
T. Nakamoto, M. Yoshikawa, T. Nakatani, Y. Yamane, S. Iwasawa, M. Matsumoto, et al.
Microscopic polyangiitis that presented liver dysfunction prior to noted renal manifestations.
Intern Med, 39 (2000), pp. 517-521
[35.]
L. Guillevin, C. Pagnoux, L. Teixeira.
Microscopic polyangiitis, in vasculitis, pp. 355-364
[36.]
L. Guillevin, C. Pagnoux, R. Seror, A. Mahr, L. Mouthon, P. Le Toumelin, French Vasculitis Study Group (FVSG).
The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort.
[37.]
C. Pagnoux, A. Mahr, M.A. Hamidou, J.J. Boffa, M. Ruivard, J.P. Ducroix, et al.
Azathioprine or methotrexate maintenance for ANCA-associated vasculitis.
N Engl J Med, 359 (2008), pp. 2790-2803
[38.]
L. Guillevin, F. Lhote, M. Gayraud, P. Cohen, B. Jarrousse, O. Lortholary, et al.
Prognostic factors in polyarteritis nodosa and Churg Strauss syndrome. A prospective study in 342 patients.
Medicine, 75 (1996), pp. 17-28
[39.]
K. De Groot, L. Harper, D.R. Jayne, L.F. Flores Suarez, G. Gregorini, W.L. Gross, et al.
Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial.
Ann Intern Med, 150 (2009), pp. 670-680
[40.]
L. Guillevin, J.F. Cordier, F. Lhote, P. Cohen, B. Jarrousse, I. Royer, et al.
A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener's granulomatosis.
Arthritis Rheum Dec, 40 (1997), pp. 2187-2198
[41.]
K. De Groot, N. Rasmussen, P.A. Bacon, J.W. Tervaert, C. Feighery, G. Gregorini, et al.
Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody-associated vasculitis.
Arthritis Rheum, 52 (2005), pp. 2461-2469
[42.]
T.F. Hiemstra, M. Walsh, A. Mahr, C.O. Savage, K. de Groot, L. Harper, European Vasculitis Study Group (EUVAS), et al.
Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized controlled trial.
JAMA, 304 (2010), pp. 2381-2388
[43.]
D. Jayne, N. Rasmussen, K. Andrassy, P. Bacon, J.W. Tervaert, J. Dadoniene, et al.
A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies.
N Engl J Med, 349 (2003), pp. 36-44
[44.]
C. Mukhtyar, L. Guillevin, M.C. Cid, B. Dasgupta, K. de Groot, W. Gross, et al.
EULAR recommendations for the management of primary small vessel. vasculitis.
Ann Rheum Dis, 68 (2009), pp. 310-317
[45.]
D.R. Jayne, G. Gaskin, N. Rasmussen, D. Abramowicz, F. Ferrario, L. Guillevin, European Vasculitis Study Group, et al.
Randomized trial of plasma exchange or highdosage methylprednisolone as adjunctive therapy for severe renal vasculitis.
J Am Soc Nephrol, 18 (2007), pp. 2180-2188
[46.]
C. Richter, A. Schnabel, E. Csernok, K. De Groot, E. Reinhold- Keller, W.L. Gross.
Treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis with high-dose intravenous immunoglobulin.
Clin Exp Immunol, 101 (1995), pp. 2-7
[47.]
D.R. Jayne, H. Chapel, D. Adu, S. Misbah, D. O’Donoghue, D. Scott, et al.
Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity.
QJM, 93 (2000), pp. 433-439
[48.]
D.R. Jayne, M.J. Davies, C.J. Fox, C.M. Black, C.M. Lockwood.
Treatment of systemic vasculitis with pooled intravenous immunoglobulin.
Lancet, 337 (1991), pp. 1137-1139
[49.]
L. Josselin, A. Mahr, P. Cohen, C. Pagnoux, G. Guaydier- Souquieres, G. Hayem, et al.
Infliximab efficacy and safety against refractory systemic necrotising vasculitides: long-term follow-up of 15 patients.
Ann Rheum Dis, 67 (2008), pp. 1343-1346
[50.]
R.B. Jones, J.W. Cohen Tervaert, T. Hauser, R. Luqmani, M.D. Morgan, C.A. Peh, et al.
Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis.
N Engl J Med, 363 (2010), pp. 211-220
[51.]
J.H. Stone, P.A. Merkel, R. Spiera, P. Seo, C.A. Langford, G.S. Hoffman, et al.
Rituximab versus cyclophosphamide for ANCA-associated vasculitis.
N Engl J Med, 363 (2010), pp. 221-232
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