Case of microscopic polyangiitis accompanied by central nervous system symptoms and brain vasculitis observed histopathologically

: A 65-year-old-man complained of coughing and fever. The urine showed microscopic hematuria. The level of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was 167 EU. Two months later, he was admitted to our hospital with pulmonary hemorrhage and progressive renal dysfunction. He was treated with intravenous methylprednisolone followed by oral prednisolone with plasma exchanges, and his first pulmonary hemorrhage was relieved. Three weeks later, he suffered from a second diffuse pulmonary hemorrhage with central nervous system symptoms. He was treated again with intravenous methylprednisolone, plasma exchanges, and also intravenous pulse cyclophosphamide (IVCY), but he died of respiratory failure. Autopsy findings revealed microscopic polyangiitis (MPA)in the brain as well as in the lung, kidney and gastrointestinal system. The histopathological findings suggested that cerebral nervous system symptoms could have been caused by brain vasculitis in this case.