Anti-neutrophil cytoplasmic auto-antibodies-associated vasculitis with pulmonary and renal involvement

We present a 13-year-old boy with a rapidly progressive glomerulonephritis and pulmonary haemorrhage with perinuclear anti-neutrophil cytoplasmic auto-antibodies (pANCA) corresponding to anti-myeloperoxidase antibodies. The diagnosis of microscopic polyarteritis was made on the basis of the clinical features, the positivity of pANCA, and the histological finding of a pauci-immune crescentic glomerulonephritis. He responded excellently to corticosteroids and cyclophosphamide therapy and complete clinical remission persists 1 year after withdrawal of treatment. We emphasize the usefulness of ANCA antibody assays to establish a prompt diagnosis and adequate treatment in systemic vasculitis in children.

Anti-intrinsic factor antibodies in systemic lupus erythematosus

As the co-existence of pernicious anaemia (PA) and systemic lupus erythematosus (SLE) has been repeatedly reported, we have investigated the presence of anti-intrinsic factor antibodies (IFAb), the immunological hallmark of PA, in patients diagnosed with SLE. Serum cobalamin levels and IFAb were determined in 30 women diagnosed with SLE as well as in 45 controls. Cobalamin levels were low in 7/30 patients. IFAb were detected in 3/30 sera from patients but in none of the control sera. The presence of IFAb was associated with a low cobalamin concentration, anaemia and macrocytosis in only one patient. There was no evident relationship between the presence of IFAb and serological markers of SLE. We conclude that IFAb may appear in SLE patients, although the cobalamin deficiency described in SLE seems to be due to the presence of IFAb in only a minority of cases.

[Wegener's granulomatosis: a report of 6 patients]

The clinical and analytical manifestations and the evaluation of 6 patients diagnosed with Wegener's granulomatosis (WG) in the Germans Trias i Pujol Hospital between 1986-1990 are described. The most frequent clinical manifestation found were general and respiratory symptoms. Three patients presented an alteration in renal function and urinary sedimentation. Antibodies against the cytoplasm of the neutrophils (ANCA) detected by indirect immunofluorescence (IIF) were positive in 4 patients. All the patients underwent initial complete remission with immunodepressor treatment and one presented relapse of the disease at 19 months of diagnosis. Complications were: opportunistic infections obliging discontinuation of treatment in one patient, distal necrosis of the fingers requiring amputation in another patient and massive atelectasis of the right lung requiring pneumonectomy in a third patient.

Systemic lupus erythematosus and pernicious anemia in an 82-year-old woman

We describe an 82-year-old woman with systemic lupus erythematosus who developed pernicious anemia 3 years later. Although both diseases are autoimmune in origin, this association is rather rare, and only 3 other cases have been described. Pernicious anemia appeared after steroid treatment was withdrawn.