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
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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


Figure 1.
Figure 1. Thorax CT scan (a, b) and chest X-ray (c) showing bilateral diffuse infiltrates of the lung. CT: computed tomography.
Figure 2.
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 1. Laboratory Data on Admission and in Our Hospital
ParameterInitial testsTests performed in our hospitalReference 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)7.6811.9 - 15.6
Leucocytes (× 109/L)1313.24 - 11
C-reactive protein (mg/L)9079.8< 3.0
ESR (mm/h)6066< 20
BUN (mg/dL)21419715 - 39
Creatinine (mg/dL)5.697.30.6 - 1.2
MPO-ANCA (U/mL)< 10121.1< 10
PR3-ANCA (U/mL)< 20312.6< 20
Anti-GBM antibody (U)< 40202< 40
C3 (mg/dL)13311290 - 180
C4 (mg/dL)353010 - 40
Anti-ds-DNA (IU/mL)-14< 30
Antistreptolysin O (U/mL)< 25-< 116
Rheumatoid factor (IU/mL)44.726< 15
Urinary RBC (/HPF)10 - 2525 - 500 - 2
Urinary protein (g/24 h)0.721.460.05 - 0.08