Case of the Month #25 - ANCA vasculitis

Published 01/02/2022

Typical features and complications of ANCA Vasculitis

Symptoms are often subtle and non-specific and the diagnosis easily missed. Features of an active ANCA vasculitis can include:

  • Blood and Protein on urine dipstick
  • Malaise, Flu-like symptoms, myalgia
  • Weight Loss
  • ENT symptoms – Sinusitis, epistaxis, otitis media
  • Respiratory involvement – cough, dyspnoea, asthma, haemoptysis (pulmonary haemorrhage is seen as diffuse pulmonary shadowing on chest X-ray often associated with reduced haemoglobin concentration; this can be life threatening)
  • Ocular involvement – conjunctivitis, scleritis, uveitis
  • Skin involvement – palpable purpura, ulcers in up to 50% of patients
  • The heart, nervous system and GI tract may also be involved.

The only typical findings in a patient with renal ANCA vasculitis is evidence of blood and protein in the urine dip and AKI. The remainder of symptoms are often vague and overlooked.