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2018 ; 11
(2
): 372-377
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Paraneoplastic Seronegative Pauci-Immune Glomerulonephritis Associated with Lung
Adenocarcinoma Responds to Rituximab: A Case Report
#MMPMID30022938
Kancharla P
; Surapaneni BK
; Goldfinger M
; Hennrick K
; Ozeri DJ
Case Rep Oncol
2018[May]; 11
(2
): 372-377
PMID30022938
show ga
Anti-neutrophil cytoplasmic antibodies (ANCA) play an important role in the
pathogenesis of pauci-immune renal vasculitis. However, in 10% of the cases, ANCA
are absent. We present a case of a 64-year-old man with a chronic untreated
hepatitis C virus infection and Middle Eastern thalassemia who was ANCA-negative
when he was hospitalized due to acute kidney injury and accounts for an uncommon
presentation of renal vasculitis. The patient had earlier reported to have
undergone local lobectomy and adjuvant chemotherapy (carboplatin/pemetrexed) for
lung adenocarcinoma a month prior. IL-6 has been reported to be involved in the
pathophysiological cascade causing pauci-immune glomerulonephritis amongst
non-small cell lung cancer patients. Previous studies with subgroup analysis have
demonstrated that ANCA negativity has been associated with more chronic
glomerular lesions and less crescent formation, which tends to have a critical
outcome in the renal system. However, our patient underwent kidney biopsy
exhibiting active crescentic glomerulonephritis, pauci-immune type with 5
cellular crescents amongst 15 glomeruli. To our knowledge, this is the third
reported case of ANCA-negative vasculitis with typical presentation on biopsy in
non-small cell lung cancer patients.