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Nephrology 20 (2015) 110–111
Correspondence MICROSCOPIC POLYANGIITIS PRESENTING AS SPONTANEOUS SUBARACHNOID HAEMORRHAGE Xia Wang and Jinquan Wang, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China Spontaneous subarachnoid haemorrhage (SAH) caused by microscopic polyangiitis (MPA) is very rare. Herein, we present a case of MPA who presented SAH as the initial syndrome. A 24-year-old male was admitted to a local hospital emergency ward because of sudden severe headache and vomiting. On examination, his blood pressure was 135/75 mmHg, and pulse rate was 78 per min. He had nuchal rigidity and positive Kernig’s and Brudzinski’s signs. Emergent computed tomography (CT) revealed an intracranial spontaneous subarachnoid haemorrhage (SAH) (Fig. 1) while cerebral digital subtraction angiography did not show aneurysms or arteriovenous malformations. Laboratory examinations showed microscopic haematuria (2+), proteinuria (1.7 g/ 24 h), serum creatinine of 55 μmol/L and a positive MPO-ANCA (myeloperoxidase-anti-neutrophil cytoplasmic antibodies) test (the titre unknown). All other autoantibodies were negative and the serum complement level was normal. Meanwhile, he received intravenous cyclophosphamide, oral prednisone and leflunomide, and therapy to reduce intracranial pressure. 5 days after the onset of SAH, the headache had gone into remission gradually, and a cranial computed tomography (CT) was normal. However, he was admitted to the local hospital for a second time 4 months later because of severe headache with
nausea and vomiting and with hypertension (160/ 110 mmHg). Nuchal rigidity and Kernig’s and Brudzinski’s signs were not present. The cranial CT was normal. Blood tests showed that creatinine was 91.1 μmol/L, MPO-ANCA was 3.808 (enzyme linked immunosorbent assay [ELISA], normal
Nephrology 20 (2015) 110–111
Correspondence MICROSCOPIC POLYANGIITIS PRESENTING AS SPONTANEOUS SUBARACHNOID HAEMORRHAGE Xia Wang and Jinquan Wang, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China Spontaneous subarachnoid haemorrhage (SAH) caused by microscopic polyangiitis (MPA) is very rare. Herein, we present a case of MPA who presented SAH as the initial syndrome. A 24-year-old male was admitted to a local hospital emergency ward because of sudden severe headache and vomiting. On examination, his blood pressure was 135/75 mmHg, and pulse rate was 78 per min. He had nuchal rigidity and positive Kernig’s and Brudzinski’s signs. Emergent computed tomography (CT) revealed an intracranial spontaneous subarachnoid haemorrhage (SAH) (Fig. 1) while cerebral digital subtraction angiography did not show aneurysms or arteriovenous malformations. Laboratory examinations showed microscopic haematuria (2+), proteinuria (1.7 g/ 24 h), serum creatinine of 55 μmol/L and a positive MPO-ANCA (myeloperoxidase-anti-neutrophil cytoplasmic antibodies) test (the titre unknown). All other autoantibodies were negative and the serum complement level was normal. Meanwhile, he received intravenous cyclophosphamide, oral prednisone and leflunomide, and therapy to reduce intracranial pressure. 5 days after the onset of SAH, the headache had gone into remission gradually, and a cranial computed tomography (CT) was normal. However, he was admitted to the local hospital for a second time 4 months later because of severe headache with
nausea and vomiting and with hypertension (160/ 110 mmHg). Nuchal rigidity and Kernig’s and Brudzinski’s signs were not present. The cranial CT was normal. Blood tests showed that creatinine was 91.1 μmol/L, MPO-ANCA was 3.808 (enzyme linked immunosorbent assay [ELISA], normal
