ANCA May Affect Large as Well as Small Blood Vessels, Case Studies Show

ANCA vasculitis may trigger inflammation in large blood vessels as well as the small ones the disease is associated with, Japanese researchers reported after noting that three patients had developed an aortic aneurysm.

These patients had ANCA vasculitis caused by myeloperoxidase (MPO) antibodies. An aneurysm is an enlarged segment of the aorta, the body’s main artery. It makes the aorta prone to rupturing, putting patients in a life-threatening situation.

The findings contrast with scientists’ view that ANCA vasculitis is a disease affecting only smaller blood vessels. The findings prompted the research team from the Nihon University School of Medicine to suggest that doctors also scan patients’ large blood vessels after diagnosing the disease.

Researchers’ article about the results, “Aortic aneurysm as a complication of myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis,” appeared in the journal Open Medicine.

The first large-blood-vessel case the team encountered was that of a 75-year-old man who had sought care because of a worsening kidney disease. Tests showed he had MPO-ANCA antibodies. Since he also had skin signs of vasculitis, doctors diagnosed him with ANCA vasculitis with kidney insufficiency.

He received dialysis and anti-inflammatory treatment, and his signs improved. Four months later, he developed tuberculosis, and was simultaneously treated for both conditions.

Eleven months after he came to the hospital, he developed chest pain. Scanning his chest, doctors found an aortic aneurysm, which had not been there during his initial examinations.

He had surgery to correct the enlargement, and has had no complications since. Both his vasculitis and tuberculosis went into remission.

A 67-year-old man had a check-up after rapidly losing weight due to nausea and a poor appetite. A chest scan revealed an aortic aneurysm. When tests indicated that his kidneys were not working properly, doctors performed a range of exams that identified MPO-ANCA. He also ended up receiving a diagnosis of ANCA vasculitis with kidney insufficiency.

The man’s condition improved with anti-inflammatory treatment and aortic surgery.

The third patient was a 86-year-old woman. Like the others, she had signs of kidney abnormalities. Doctors discovered that she had MPO-ANCA antibodies and an aneurysm.

Her vasculitis improved when treated, but since her aortic enlargement did not appear to be growing, doctors chose not to operate. Instead, they kept a close watch on her condition.

Because aortic aneurysms often fail to generate symptoms, the researchers said doctors should do chest scans to make sure newly identified ANCA vasculitis patients do not have enlarged arteries as well.