Abstract: PUB366
Copper Intrauterine Device-Associated ANCA Vasculitis: Rare Entity or a Coincidence?
Session Information
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Kaur, Gurwant, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
- Banker, Himanshi, Maulana Azad Medical College, New Delhi, DL, India
Introduction
Drug-induced vasculitis involves inflammation of blood vessels and is causally related to medication exposure; resolution or improvement typically follows withdrawal of the offending agent. Pathogenesis usually involves forming immune complexes, generating neutrophil extracellular traps (NETs) and autoantibodies, especially antineutrophil cytoplasmic antibodies (ANCA). We are presenting a case of resolution of ANCA positivity after removal of an IUD (intrauterine device).
Case Description
A 50-year-old-female with a past medical history of hyperlipidemia, asthma, migraine, mild obesity, and pre- diabetes on metformin and empagliflozin presented to the clinic for evaluation of albuminuria of 139 mg/gm of creatinine (<30 mg/g) without hematuria with well preserved kidney function (serum creatinine of 0.77 mg/dl (0.59–1.04 mg/dl) and estimated glomerular filtration rate of >90 ml/min/1.73m2). Random urine protein/creatinine (UPC) was 0.17. She saw a dermatologist for a rash four months before presenting for possible dermatitis, psoriasis, and hidradenitis suppurativa. Skin biopsy wasn’t considered. She was prescribed topical tacrolimus and clindamycin, along with oral doxycycline. Workup was positive for isolated perinuclear (p) ANCA (160 titer; normal <20). She had a Paragard (copper) IUD inserted eight years ago. Because of recent vaginal bleeding, it was decided to remove it. She had a retained IUD after an unsuccessful attempt. One month later, p-ANCA had a titer of 640. The IUD was removed in the interim. ANCA came back negative six months later. The rest of her medications, along with the absence of hematuria and proteinuria, remained unchanged.
Discussion
We highlight a rare case of ANCA-positive suspected renal vasculitis following IUD insertion; copper possibly acted as a trigger. Cutaneous small vessel vasculitis has been documented in association with chronic hepatitis A or C, oral contraception, hydralazine, propylthiouracil, allopurinol, β-lactams, streptokinase, tamoxifen, influenza vaccines, and environmental risk factors (silica exposure, farming, and chronic colonization with Staphylococcus aureus). One other case report has proposed a possible link between a copper-IUD and ANCA-associated retinal vasculitis, which was resolved following IUD removal. One caveat is the lack of a kidney or skin biopsy, as our patient declined.