An unusual cause for fever : a case report on microscopic polyangiitis

Abstract

Microscopic polyangiitis (MPA) is a small-vessel vasculitis which results in pauci-immune necrotizing inflammation of blood vessel walls. In this report, we describe a case of MPA in a 65-year old female who presented with a 1 month history of lower back pain followed by reduced appetite, weight loss and fever. An immunology screen detected perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) with myeloperoxidase (MPO) specificity in the serum. A renal biopsy was obtained because of mild proteinuria on urinalysis and revealed a small vessel vasculitis consistent with MPA. She is being treated with glucocorticoids and cyclophosphamide which resulted in a positive clinical response, with resolution of fever and improvement in her inflammatory markers. Currently she is stable and since starting treatment, she has not had any relapses or flare ups.