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Case Reports
. 2021 Feb 1;14(2):e239031.
doi: 10.1136/bcr-2020-239031.

Polyangiitis overlap syndrome: a novel presentation of microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis

Nidaa Rasheed  1   2 , Rahul Ahuja  2 , Hena Borneo  2
Affiliations
Case Reports

Polyangiitis overlap syndrome: a novel presentation of microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis

Nidaa Rasheed et al. BMJ Case Rep. .

Abstract

Polyangiitis overlap syndrome (POS) is a diagnostic term coined by Leavitt and Fauci that characterises patients with overlapping features of more than one vasculitis. Prior case studies of antineutrophil cytoplasmic antibodies (ANCA)-associated POS have only been published in patients with eosinophilic granulomatosis with polyangiitis (EGPA) and granulomatosis with polyangiitis alongside proteinase-3/cytoplasmic (C)-ANCA positivity. We present a case of a 60-year-old woman with dyspnoea, hemoptysis, positive perinuclear-ANCA and renal biopsy demonstrating evidence of microscopic polyangiitis. In addition, our patient also had asthma, mononeuritis multiplex, eosinophilia and migratory pulmonary infiltrates, thus fulfilling the criteria for EGPA. This novel case report suggests that POS is not limited to C-ANCA positivity and has variable presentations.

Keywords: cardiovascular medicine; drugs and medicines; vasculitis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT chest without contrast—on admission: imaging revealed several enlarged mediastinal lymph nodes with diffuse mild ground-glass opacities, with consolidation in right upper lobe and calcified granuloma in right lower lobe.
Figure 2
Figure 2
High Resolution CT chest—2 months post admission/on discharge: imaging revealed new patchy consolidation in left lower lobe, ground-glass opacities, calcified granuloma in right lower lobe and diffuse bronchial wall thickening.
Figure 3
Figure 3
CT chest without contrast—6 months post discharge: imaging revealed persistent bilateral ground-glass opacity with a more dependent opacity in the posterior right upper lobe, right lower lobe calcified granuloma and new moderate pericardial effusion.
Figure 4
Figure 4
Clinical course of patient’s serology results, symptom remission and treatment plan. AEC, absolute eosinophil count; ANA, antinuclear antibody; Cr, creatinine; P-ANCA, perinuclear antineutrophil cytoplasmic antibodies; MPO-ANCA, myeloperoxidase antineutrophil cytoplasmic antibodies; UA, urine analysis; UPC, urine protein/creatinine ratio.
See this image and copyright information in PMC

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