A RISE IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY IN A PATIENT WITH SYSTEMIC VASCULITIS IN REMISSION

We report a 42-year-old man who showed alveolar hemorrhage and glomeru lonephritis as well as episcleritis and skin rash. He had an extremely high titer of cytoplasm-staining antineutrophil cytoplasmic antibody (C-ANCA) and was diagnosed as having systemic vasculitis based on hist ological findings of kidney and skin biopsies. After immunosuppressive therapy clinical manifestations resolved within several weeks and C-A NCA titers commensurably declined. C-ANCA titers, however, increased a gain and remained high despite clinical remission. In general, there i s a close relationship between ANCA titers and clinical activities in ANCA-associated diseases, but they displayed a large discrepancy in th is patient. Indeed, the serum of the patient in remission contained th e antibody against 29-kD neutrophil extracts which was detected by imm unoblot analysis. These findings suggest that C-ANCA may not necessari ly be, by itself, pathogenetic for the development of the vasculitis.