J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 12, Number 10, October 2021, pages 405-410

A Rare Case of Pulmonary-Renal Syndrome With Triple-Seropositive for Myeloperoxidase-Anti-Neutrophil Cytoplasm Antibody (MPO-ANCA), Proteinase 3 (PR3)-ANCA and Anti-Glomerular Basement Membrane (GBM) Antibodies

Figures

Figure 1. Thorax CT scan (a, b) and chest X-ray (c) showing bilateral diffuse infiltrates of the lung. CT: computed tomography.

Figure 2. Kidney biopsy findings. Photomicrograph showing (a) three glomeruli with cellular crescents, associated with mildly interstitial fibrosis and moderate inflammatory infiltrate (H&E, × 100); (b) glomerulus with a cellular crescent (Masson’s trichrome, × 400); (c) Jones methenamine silver staining delineating glomerular and tubular basement, also showing a cellular crescent (× 400); (d) immunofluorescence staining revealing strong linear immunoglobulin G (3+) along the glomerular basement membrane. H&E: hematoxylin and eosin.

Table

**Table 1.** Laboratory Data on Admission and in Our Hospital
Parameter	Initial tests	Tests performed in our hospital	Reference value
ANA: anti-nuclear antibody; BUN: blood urea nitrogen; ESR: erythrocyte sedimentation rate; MPO-ANCA: myeloperoxidase-anti-neutrophil cytoplasm antibody; GBM: glomerular basement membrane; RBC: red blood cell; HPF: high-power field; NA: not applicable.
Hemoglobin (g/dL)	7.6	8	11.9 - 15.6
Leucocytes (× 10⁹/L)	13	13.2	4 - 11
C-reactive protein (mg/L)	90	79.8	< 3.0
ESR (mm/h)	60	66	< 20
BUN (mg/dL)	214	197	15 - 39
Creatinine (mg/dL)	5.69	7.3	0.6 - 1.2
MPO-ANCA (U/mL)	< 10	121.1	< 10
PR3-ANCA (U/mL)	< 20	312.6	< 20
Anti-GBM antibody (U)	< 40	202	< 40
C3 (mg/dL)	133	112	90 - 180
C4 (mg/dL)	35	30	10 - 40
ANA	-	1/80	NA
Anti-ds-DNA (IU/mL)	-	14	< 30
Antistreptolysin O (U/mL)	< 25	-	< 116
Rheumatoid factor (IU/mL)	44.7	26	< 15
Urinary RBC (/HPF)	10 - 25	25 - 50	0 - 2
Urinary protein (g/24 h)	0.72	1.46	0.05 - 0.08