Treating ANCA Vasculitis in Cancer Patients Best Approach, Case Study Suggests

When autoimmune diseases such as ANCA-associated vasculitis are found at the same time as cancer, properly diagnosing and treating them alongside the cancer is crucial to ensuring best outcomes for the patient, a case report suggests.

The study, “Simultaneous Occurrence of Sarcoidosis and Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis in a Patient with Lung Cancer,” was published in the journal Internal Medicine.

Autoimmune diseases such as ANCA-associated vasculitis and sarcoidosis — a systemic disease characterized by the formations of clumps of inflammatory cells called granulomas — can appear at the same time as cancer. In such cases, doctors have to choose among treatments to avoid complications.

Researchers in Japan describe a 71-year-old woman who was diagnosed and treated for lung cancer, sarcoidosis, and ANCA vasculitis.

She went to the hospital after an abnormal shadow was found on lung X-rays. She did not have any symptoms, was in overall good health, took medication for high blood pressure, did not smoke, and had no history of kidney disease.

Lab exams showed anemia, excessive calcium, markers of kidney failure and inflammation like proteins and blood in the urine and high creatinine, and two markers of cancer. The patient also had high levels of ANCAs against the myeloperoxidase protein (MPO-ANCAs).

Imaging exams showed a mass and a nodule in the lung, and enlarged lymph nodes. A biopsy confirmed that the mass was lung cancer, and that the lung nodule and irregularities in the lymph nodes were caused by sarcoidosis granulomas.

“The pulmonary nodule and thoracic lymphadenopathy [abnormalities in the lymph nodes of the torax] caused by sarcoidosis, which radiologically mimicked lung cancer metastases, were correctly diagnosed by a thoracoscopic biopsy,” the researchers said.

The kidney biopsy showed nephritis — an internal inflammation of the kidneys, areas of dead tissue, and granulomas.

The patient was diagnosed with stage 2 lung cancer, pulmonary and lymph node sarcoidosis, and nephritis due to sarcoidosis and ANCA vasculitis. Her doctors found no signs of sarcoidosis or ANCA vasculitis in other organs.

The woman received oral prednisolone — a steroid medication — to improve kidney function, and radiation therapy to treat her cancer. The doctors decided not to remove the tumor because the patient did not want to undergo surgery, and the steroid treatment increased the risk of post-surgery complications.

Kidney function improved after four months of prednisolone treatment. After six months, the patient’s lymph nodes had returned to their normal size, and she had no detectable MPO-ANCAs. There were no further complications due to ANCA vasculitis or sarcoidosis, even though the dose of prednisolone was reduced gradually.

The researchers concluded that “because sarcoidosis and AAV occasionally occur in association with cancer and influence the diagnosis and treatment of that cancer, their accurate diagnosis, and appropriate management are crucial.”