Aortic Aneurysm as a Complication of Myeloperoxidase-antineutrophil Cytoplasmic Antibody-associated Vasculitis

ANCA-associated vasculitis with abdominal aortic aneurysm : Case report and literature review

INTRODUCTION

ANCA-associated vasculitis is an autoimmune disease that usually involves the small vessel walls. It is difficult to find the presence of ANCA-associated vasculitis in the great arteries, especially the thoracic and abdominal aorta.

METHODS

This is an 86-year-old Chinese man with ANCA-associated vasculitis and abdominal aortic aneurysm who presented with epigastric pain. Considering his age and physical condition, the patient was treated with methylprednisolone and mycophenolate mofetil instead of surgery.

RESULTS

The patient's epigastric pain symptoms were relieved after 2 months of conservative treatment. Imaging at follow-up 2 years later showed signs of aneurysm enlargement because of irregular medication.

CONCLUSIONS

Patients with ANCA-associated vasculitis combined with aortic aneurysm often require surgical management. But for patients with stable disease and poor physical conditions, conservative treatment is also an effective treatment method, which can bring benefits to the patient's survival.

Antineutrophil Cytoplasmic Antibody Positivity Is Associated with Vascular Involvement in Behçet's Disease

PURPOSE

We investigated whether antineutrophil cytoplasmic antibody (ANCA) positivity is associated with vascular manifestations at diagnosis of Behçet's disease (BD) and poor outcomes during follow-up.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 1060 patients with BD. Among them, 808 patients could be diagnosed with BD based on the revised version of the International Criteria for Behçet's Disease (ICBD) in 2014 (2014 ICBD criteria) and 588 patients could be diagnosed with BD based on the International Study Group (ISG) criteria proposed in 1990 (1990 ISG criteria). We examined the sites and patterns of vascular involvement in the BD patients at diagnosis and evaluated adverse outcomes during follow up, such as all-cause mortality, acute coronary syndrome, and deep vein thrombosis.

RESULTS

Among the 808 patients with BD based on the 2014 ICBD criteria, the rate of ANCA positivity at diagnosis was 2.2%. ANCA-positive BD patients exhibited a higher frequency of overall vascular manifestations (22.2% vs. 6.1%) and higher frequencies of vascular involvement in the upper extremities and visceral arteries than ANCA-negative BD patients (5.6% vs. 0.1% and 5.6% vs. 0.1%). Among the 588 BD patients based on the 1990 ISG criteria, similarly, ANCA-positive BD patients exhibited a higher frequency of vascular manifestations than ANCA-negative BD patients. ANCA positivity, however, did not seem to be associated with poor outcomes in BD patients during follow up.

CONCLUSION

ANCA positivity in BD patients was found to be associated with cross-sectional vascular involvement in the upper extremities and visceral arteries at diagnosis but was not predictive of poor outcomes during follow-up.