Diffuse alveolar hemorrhage in a patient with anti-neutrophil cytoplasm antibody-associated vasculitis successfully treated with immunoadsorption combined with methylprednisolone

Introduction: Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare and lifethreatening autoimmune disease. Immunoadsorption (IA) is a potential approach in treating AAV. Patients and methods: A 76-year-old male patient was admitted with hemoptysis and oliguria, progressed rapidly into pulmonary hemorrhaging, acute kidney damage, and multi-organ failure. He was diagnosed as MPO-ANCA-positive vasculitis by immunological detection and kidney biopsy in the case report. IA combined with methylprednisolone to induce and alleviate the disease effectively, and cyclophosphamide (0.2 g every other day, a total of 1 g for the first time, after the patients tolerated, 10 mg/kg every 3 weeks for 6 months in total) combined with prednisone for maintenance therapy. Results and discussion: Although both kidneys suffered severe deterioration requiring long-term hemodialysis replacement therapy, their pulmonary function was restored. Furthermore, clinical and serological symptoms of the disease were successfully controlled. Consequently, IA treatment may quickly remove IgG and ANCA to efficiently control clinical symptoms, especially in patients presenting with alveolar hemorrhaging and acute renal failure. (c) 2021 The Authors. Published by Elsevier Espan tilde a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).