PMID- 34126959 OWN - NLM STAT- MEDLINE DCOM- 20220201 LR - 20220201 IS - 1471-2369 (Electronic) IS - 1471-2369 (Linking) VI - 22 IP - 1 DP - 2021 Jun 14 TI - Anti-neutrophil cytoplasmic antibody-associated vasculitis accompanied by type II heparin-induced thrombocytopenia resulting in asymptomatic cerebral infarction: a case report. PG - 220 LID - 10.1186/s12882-021-02433-8 [doi] LID - 220 AB - BACKGROUND: Heparin-induced thrombocytopenia (HIT) involves platelet activation and aggregation caused by heparin or HIT antibodies associated with poor survival outcomes. We report a case of HIT that occurred after hemodialysis was started for rapidly progressive glomerulonephritis (RPGN), which was caused by anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), and ultimately resulted in asymptomatic cerebral infarction. CASE PRESENTATION: A 76-year-old Japanese man was urgently admitted to our hospital for weight loss and acute kidney injury (serum creatinine: 12 mg/dL). Hemodialysis therapy was started using heparin for anticoagulation. Blood testing revealed elevated titers of myeloperoxidase anti-neutrophil cytoplasmic antibodies, and renal biopsy revealed crescentic glomerulonephritis with broad hyalinization of most of the glomeruli and a pauci-immune staining pattern. These findings fulfilled the diagnostic criteria for microscopic polyangiitis, and the patient was diagnosed with RPGN caused by AAV. Steroid pulse therapy, intermittent pulse intravenous cyclophosphamide, and oral steroid therapy failed to improve the patient's renal function, and maintenance dialysis was started. However, on day 15, his platelet count had decreased to 47,000/microL, with clotting observed in the hemodialysis catheter. Magnetic resonance imaging of the head identified acute asymptomatic brain infarction in the left occipital lobe, and a positive HIT antibody test result supported a diagnosis of type II HIT. During hemodialysis, the anticoagulant treatment was changed from heparin to argatroban. Platelet counts subsequently normalized, and the patient was discharged. A negative HIT antibody test result was observed on day 622. CONCLUSIONS: There have been several similar reports of AAV and HIT co-existence. However, this is a rare case report on cerebral infarction with AAV and HIT co-existence. Autoimmune diseases are considered risk factors for HIT, and AAV may overlap with other systemic autoimmune diseases. To confirm the relationship between these two diseases, it is necessary to accumulate more information from future cases with AAV and HIT co-existence. If acute thrombocytopenia and clotting events are observed when heparin is used as an anticoagulant, type II HIT should always be considered in any patient due to its potentially fatal thrombotic complications. FAU - Furuto, Yoshitaka AU - Furuto Y AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. furuto19761006@yahoo.co.jp. FAU - Kawamura, Mariko AU - Kawamura M AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Yamashita, Jumpei AU - Yamashita J AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Yoshikawa, Takahiro AU - Yoshikawa T AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Namikawa, Akio AU - Namikawa A AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Isshiki, Rei AU - Isshiki R AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Takahashi, Hiroko AU - Takahashi H AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. FAU - Shibuya, Yuko AU - Shibuya Y AD - Department of Hypertension and Nephrology, NTT Medical Centre, 5-9-22, Higasi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan. LA - eng PT - Case Reports PT - Journal Article DEP - 20210614 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Anticoagulants) RN - 9005-49-6 (Heparin) SB - IM MH - Aged MH - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*complications MH - Anticoagulants/*adverse effects MH - Asymptomatic Diseases MH - Cerebral Infarction/diagnostic imaging/*etiology MH - Glomerulonephritis/complications/pathology/therapy MH - Heparin/*adverse effects MH - Humans MH - Magnetic Resonance Imaging MH - Male MH - Renal Dialysis MH - Thrombocytopenia/*chemically induced/*complications PMC - PMC8204417 OTO - NOTNLM OT - Anti-neutrophil cytoplasmic antibody-associated vasculitis OT - Argatroban OT - Autoimmune disease OT - Cerebral infarction OT - Heparin OT - Heparin-induced thrombocytopenia OT - Nafamostat OT - Rapidly progressive glomerulonephritis COIS- The authors declare that they have no competing interests. EDAT- 2021/06/16 06:00 MHDA- 2022/02/02 06:00 PMCR- 2021/06/14 CRDT- 2021/06/15 05:49 PHST- 2020/08/31 00:00 [received] PHST- 2021/06/08 00:00 [accepted] PHST- 2021/06/15 05:49 [entrez] PHST- 2021/06/16 06:00 [pubmed] PHST- 2022/02/02 06:00 [medline] PHST- 2021/06/14 00:00 [pmc-release] AID - 10.1186/s12882-021-02433-8 [pii] AID - 2433 [pii] AID - 10.1186/s12882-021-02433-8 [doi] PST - epublish SO - BMC Nephrol. 2021 Jun 14;22(1):220. doi: 10.1186/s12882-021-02433-8.