1Mais Mamoon, 1Dr.Mohamed Hefzy, 1Ahmed Elmansoury
1Thumbay Hospital
Purpose Statement:
Case presentation of microscopic polyangiitis with early diagnosis and earlier treatment.
Method(s):
Microcytic hypo chromic anemia is common form of anemia especially in young females. Microcytic hypo chromic anemia is primarily caused by fall in iron store below normal acceptable level. This type of Anemia is known as Iron deficiency anemia (IDA). It is usually related to unhealthy diet, blood loss from heavy menses or presence of underlying systemic condition.
In terms of blood loss always there is a chance of invisibility of the site of bleeding .For example diffuse alveolar hemorrhage (DAH) in which there is bleeding into the alveolar spaces of the lungs. DAH is caused by injury of alveolar-capillary basement membrane.DAH is reflected in practice as Cough, fever, hemoptysis and Dyspnea.
IDA and DAH are part of Microscopic polyangiitis (MPA) which is an uncommon systemic disease. It is the result of blood vessel inflammation (vasculitis), which can damage organ systems. The sites most commonly affected by MPA include the kidneys, lung, nerves, skin, and joints.
Result(s): Here is a case report of a young lady who was underestimated since one year .Her compliant was refractory anemia and recurrent hemoptysis .Finally she presented in a critical situation. In contrast to previously , this time she was immediately diagnosed as a case of refractory Microcytic hypo chromic anemia , DAH , incidental findings of renal involvement and recurrent eye pain .She was admitted to intensive care and after hemodynamics stabilizations her kidney biopsy confirmed Microscopic Polyangiitis, She was treated accordingly with Steroids, Cyclophosphamide .
Conclusion(s): Our message is that anemia which is refractory to the usual Iron supplements is an important clue to an alternative diagnosis. Small-vessel vasculitis should be suspected in any patient who presents with a multisystem disease that is not caused by an infectious or malignant process. She might be diagnosed earlier if we increase awareness of Physicians of referring to rheumatologist when no obvious explanation of anemia