TY - JOUR
T1 - Opportunistic infections are preceded by a rapid fall in antineutrophil cytoplasmic antibody (ANCA) titer in patients with ANCA associated vasculitis
AU - Palsson, Runolfur
AU - Choi, Hyon K.
AU - Niles, John L.
PY - 2002
Y1 - 2002
N2 - Objective. To study the clinical course and changes in antineutrophil cytoplasmic antibody (ANCA) titers in patients with ANCA associated vasculitis (AAV) who developed opportunistic infections. Methods. Among the patients with AAV tested in the Immunopathology Laboratory at the Massachusetts General Hospital between 1989 and 1998, all patients who experienced opportunistic infections (n = 16) were included. We retrospectively studied their clinical features and examined the relationship between changes in ANCA titer and the onset of the opportunistic infections. ANCA titers were measured by antigen-specific ELISA. Results. Of the 16 AAV patients with opportunistic infection, 15 had no evidence for active vasculitis at the time of the infection. Among these 15 patients, opportunistic infections were associated with a steep fall in ANCA titers. There was no consistent pattern of change in C-reactive protein levels. In 7 patients, the immunosuppressive regimen was increased for new clinical findings shortly before the diagnosis of an opportunistic infection, despite the absence of histologic documentation of active vasculitis. Three of these 7 patients died. One patient, who did not experience a significant fall in ANCA titer, i.e., less than 4-fold from his prior peak, was simultaneously found to have Pneumocystis carinii pneumonia and biopsy proven active vasculitis. Conclusion. Our data strongly suggest that opportunistic infections in patients with AAV are associated with negative or rapidly falling ANCA titers. Therefore, changes in ANCA titer can help distinguish opportunistic infections from vasculitis flares when patients with AAV present with indeterminate clinical findings.
AB - Objective. To study the clinical course and changes in antineutrophil cytoplasmic antibody (ANCA) titers in patients with ANCA associated vasculitis (AAV) who developed opportunistic infections. Methods. Among the patients with AAV tested in the Immunopathology Laboratory at the Massachusetts General Hospital between 1989 and 1998, all patients who experienced opportunistic infections (n = 16) were included. We retrospectively studied their clinical features and examined the relationship between changes in ANCA titer and the onset of the opportunistic infections. ANCA titers were measured by antigen-specific ELISA. Results. Of the 16 AAV patients with opportunistic infection, 15 had no evidence for active vasculitis at the time of the infection. Among these 15 patients, opportunistic infections were associated with a steep fall in ANCA titers. There was no consistent pattern of change in C-reactive protein levels. In 7 patients, the immunosuppressive regimen was increased for new clinical findings shortly before the diagnosis of an opportunistic infection, despite the absence of histologic documentation of active vasculitis. Three of these 7 patients died. One patient, who did not experience a significant fall in ANCA titer, i.e., less than 4-fold from his prior peak, was simultaneously found to have Pneumocystis carinii pneumonia and biopsy proven active vasculitis. Conclusion. Our data strongly suggest that opportunistic infections in patients with AAV are associated with negative or rapidly falling ANCA titers. Therefore, changes in ANCA titer can help distinguish opportunistic infections from vasculitis flares when patients with AAV present with indeterminate clinical findings.
KW - Antineutrophil cytoplasmic antibodies
KW - Opportunistic infection
KW - Vasculitis
UR - http://www.scopus.com/inward/record.url?scp=0036197707&partnerID=8YFLogxK
M3 - Article
C2 - 11908563
AN - SCOPUS:0036197707
SN - 0315-162X
VL - 29
SP - 505
EP - 510
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 3
ER -