Tuberc Respir Dis.  2012 Feb;72(2):197-202.

A Case of Microscopic Polyangiitis Presented as Pleural Effusion

• Shin JK
• Kwon SS
• Park KH
• Lee HJ
• Kim YH

Abstract

Microscopic polyangiitis is a necrotizing vasculitis, characterized by inflammation of small vessels (capillaries, venules, and arterioles) with few or no immune deposits. The kidneys are the most commonly affected organs and are involved in 90% of patients, whereas pulmonary involvement occurs in a minority of cases (10% to 30%). In cases of lung disease, diffuse alveolar hemorrhage with pulmonary capillaritis is the most common manifestation. Microscopic polyangiitis is strongly associated with antineutrophil cytoplasmic autoantibody, which is a useful diagnostic serological marker. We report a case of microscopic polyangiitis presented as pleural effusion in a 67-year-old female. Pleural effusions have been reported in some cases previously, but the number of cases were small and their characteristics have not been well described. This report describes characteristic findings of pleural fluid and its histological features in a case of microscopic polyangiitis.

Keyword

Microscopic Polyangiitis; Pleural Effusion; Antibodies, Antineutrophil Cytoplasmic

MeSH Terms

Aged
Antibodies, Antineutrophil Cytoplasmic
Cytoplasm
Female
Hemorrhage
Humans
Inflammation
Kidney
Lung Diseases
Microscopic Polyangiitis
Pleural Effusion
Vasculitis
Venules
Antibodies, Antineutrophil Cytoplasmic

Figure

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  Figure 1 Petechiae on the right lower extremity is noted.

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  Figure 2 Initial chest X-ray shows right pleural effusion (A) and shifting of the right pleural effusion in the right decubitus view (B).

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  Figure 3 Contrast enhanced CT scan shows right pleural effusion and parietal pleural thickening. CT: computed tomography.

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  Figure 4 Extravasation of red blood cell (arrow) and perivascular mild mononuclear cell infiltration are found in skin biopsy (H&E stain, ×200).

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  Figure 5 (A) An interlobular artery shows fibrinoid necrosis (arrow) with perivascular mononuclear cell infiltration (H&E stain, ×200). (B) Celluar crescents (arrow) are found in glomeruli (PAS stain, ×400).

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  Figure 6 The vascular walls are infiltrated by lymphocytes (arrow) in pleural biopsy (H&E stain, ×200).

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  Figure 7 One month after steroid therapy, chest X-ray shows a regression of previously noted right pleural effusion.

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