Microscopic polyangiitis complicated with cerebral infarction and hemorrhage: a case report and review of literature

Abstract

We report a case of MPA with cerebral infarction and hemorrhage. A 72-year-old man was admitted to our hospital because of high fever, speech failure, and weakness of the left limbs in April 2008. Magnetic resonance imaging of the head showed cerebral infarction at the right corona radiata. Mononeuropathy multiplex and renal dysfunction (Cr 1.46 mg/dl) were noted. Urinalysis revealed occult blood, proteinuria and granular casts. White blood cell count was 11960/ul, CRP concentration was 12.9 mg/dl, and the MPO-ANCA titer was 330 EU. Computed tomography of the abdomen revealed arterial aneurysms in the kidney. The patient was diagnosed with microscopic polyangiitis (MPA). On the 8th day after hospital admission, a new cerebral hemorrhage occurred at the right thalamus. Prednisolone (1 mg/kg/day) and intravenous pulse cyclophosphamide (200 mg) were initiated. Because the patient's MPA was refractory, methylprednisolone pulse therapy (1000 mg/dayx3 days) was added to his treatment regimen, and he received plasma exchange (20 U/day) and double filtration plasmapheresis twice each ; after this, his MPA recovered. Cerebral infarction and hemorrhage are rare complications in MPA and are associated with poor prognosis. Published literature on these complications is reviewed.