Fortuitous Vasculitis

Figures & data

Figure 1. Changes in creatinine, estimated glomerular filtration rate (eGFR), and C-reactive protein (CRP) over time.

Table 1. Results of hematological and biochemical investigations.

Test	Day 0	Day 92	Day 127	Reference range
Urea (mg/dL)	65.8	31.9	48.5	7.0–18.7
Creatinine (mg/dL)	4.28	1.47	2.02	0.92–1.97
eGFR (mL/min)	20	54	46	>90
Hemoglobin (g/dL)	9.7	14.4	13.5	13.0–18.0
White blood cell count (10^3/μL)	3.32	3.70	0.27	4.0–11.0
Platelets (10^3/μL)	110	153	113	150–400
Neutrophils (10^3/μL)	1.95	2.48	0.02	2.0–7.5
Lymphocytes (10^3/μL)	0.98	0.41	0.2	1.0–4.8
CRP (mg/dL)	1.4	0.9	3.7	<0.5

Note: eGFR, estimated glomerular filtration rate; CRP, C-reactive protein.

Table 2. Results of additional investigations.

Test	Result	Reference range
Angiotensin-converting enzyme (IU/L)	143	8.0–55.0
Rheumatoid factor (IU/mL)	773	<20
Antineutrophil cytoplasmic antibody	Negative
Antiglomerular basement membrane antibody	Negative
Antinuclear antibody	Negative
Extractable nuclear antigens	Negative
Human lysosomal membrane protein antibodies	Negative
C3 (mg/dL)	73.0	75.0–165.0
C4 (mg/dL)	25.0	14.0–54.0
Hepatitis C immunoglobulin G	Negative
Hepatitis B surface antigen	Negative
Human T cell lymphotrophic virus-1	Negative
Human immunodeficiency virus 1&2 antibodies	Negative

Figure 2. Renal biopsy. Glomerulus showing an acute segmental lesion (arrowed) with a well-demarcated collection of cells in Bowman’s space, overlying a capillary loop with thrombosis and disruption of the basement membrane, characteristic of an acute necrotizing crescentic glomerulonephritis with an index of chronicity of 20%. The immunoperoxidase study showed no significant deposition of immunoproteins in the glomeruli.

Figure 3. Ziehl–Neelsen (ZN) staining of right ventricular pacing lead vegetation. This shows numerous acid and alcohol fast bacilli (AAFB) on direct staining and grew Mycobacterium fortuitum upon culture.