Abstract
An 82-year-old female was referred to our hospital because of low-grade fever, anemia, and rapidly progressive nephritic syndrome. Her laboratory data showed mild proteinuria, mild renal failure, and the presence of myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody. A skin biopsy specimen taken from the erythematous purpura revealed neutrophilic infiltration around the blood vessels with fibrinoid changes in the vessel walls. A renal biopsy specimen revealed segmental necrotizing glomerulonephritis with fibro-cellular crescent formation without deposits of immunoglobulin or complement components, indicating microscopic polyangiitis. The use of corticosteroid treatment, including intravenous methylprednisolone, improved renal failure. After 4 years with low-dose maintenance corticosteroid therapy, she developed de novo acute hepatitis B, and entecavir was remarkably effective, showing a rapid recovery from liver dysfunction with jaundice. To prevent hepatitis B virus (HBV) reactivation and de novo acute hepatitis B induced by immunosuppressive or cytotoxic therapy, including corticosteroids alone, the measurement of HBV-related serological markers needs to be performed prior to the initiation of such therapy, eve...Continue Reading
References
Jan 1, 1986·Annals of Internal Medicine·J H HoofnagleL B Seeff
Sep 27, 2007·Internal Medicine Journal·J S LubelP W Angus
Oct 19, 2007·Kidney International·F C FervenzaD C Cattran
Jan 7, 2009·Annals of Internal Medicine·Tatyana A ShamliyanTimothy J Wilt
Jan 23, 2009·Rheumatology International·Kai-Chung TseTak Mao Chan
Jun 23, 2009·International Journal of Hematology·Shigeru KusumotoRyuzo Ueda
Aug 29, 2009·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Anna S F Lok, Brian J McMahon
Jul 16, 2010·Respirology : Official Journal of the Asian Pacific Society of Respirology·Tae-Wan KimYou-Young Kim
Mar 19, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Nicholas MansfieldAlan D Salama
Apr 8, 2011·World Journal of Gastroenterology : WJG·María Luisa Manzano-Alonso, Gregorio Castellano-Tortajada
Jun 2, 2011·Clinical and Experimental Nephrology·Waka Ohishi, Kazuaki Chayama
Jul 30, 2011·World Journal of Gastroenterology : WJG·Timothée NoterdaemeOlivier Detry
Oct 26, 2011·World Journal of Gastroenterology : WJG·Claudio M MastroianniVincenzo Vullo
Feb 22, 2012·Clinical and Experimental Nephrology·Kunihiro YamagataSeiichi Matsuo
Feb 1, 2012·Clinical Kidney Journal·Maria GarjauDaniel Serón