Hyperinfection syndrome in a microscopic polyangiitis patient after treatment with immunosuppressive drugs
Abstract
A 66-year-old man with a history of microscopic polyangiitis, type 2 diabetes mellitus, bronchiectasis, and emphysema presented to Jiangxi Provincial People's Hospital on September 28, 2021. The patient's major symptoms were fever, diarrhea, cough with sputum for the past month, and gangrene of the lip for the past 6 days. The patient was a farmer residing in Jiangxi Province, who was a nonsmoker with no travel history. In June 2020, his serologies were positive for perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) at 1:1280 and myeloperoxidase (MPO) at 209.9 (0–20) U/mL. His creatinine level was 411 (57–111) μmol/L. Renal ultrasound suggested renal atrophy, and computed tomography (CT) of the lungs revealed interstitial lesions. The diagnosis was microscopic polyangiitis, antineutrophil cytoplasmic antibodies (ANCA)-associated nephritis, and interstitial pneumonia. The administered treatments were glucocorticoids (starting dose of methylprednisolone at 40 mg/day, followed by a gradual reduction to a maintenance dose of prednisone at 10 mg/day), cyclophosphamide (intermittent use from June 2020 to August 2021, totaling 5.0 g), and compound sulfamethoxazole (two tablets every 12 h) for the prevention of Pneumocystis jirovecii (P. jirovecii). The patient developed fever, diarrhea with chills, nausea, vomiting, and a cough with sputum after exertion in August 2021. He consulted another hospital on September 3, 2021, and blood cultures showed a multidrug-resistant…
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