Abstract: FR-PO0760
An Uncommon Presentation of ANCA-Associated Vasculitis: Gallbladder Involvement with Rapid Progressive Glomerulonephritis
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Wiesner, Joshua G., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Gutierrez, Omar, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Chung, Madeline S., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Introduction
ANCA Associate Vasculitis (AAV) is a rare group of vasculitides involving small to medium-sized vessels, most often the kidneys, lungs and skin. Rarely, it can involve the gastrointestinal tract, including the gallbladder, mimicking acute cholecystitis. We present the case of a patient with right upper pain and acute kidney injury subsequently diagnosed as microscopic polyangiitis.
Case Description
A 67-year-old African American woman with hypertension, asthma and chronic left leg deep vein thrombosis presented with six weeks of abdominal pain, nausea, vomiting, decreased appetite and lower extremity weakness. She had upper respiratory symptoms one week prior and no history of autoimmune disease.
Labs showed a serum creatinine of 2.5 mg/dL, baseline 0.7 mg/dL. Urine analysis revealed trace protein, 71 RBCs per HPF and 10 WBC per HPF; prior was normal. HIDA scan and MRCP showed signs of acute cholecystitis. The initial impression was acute cholecystitis with ATN from poor oral intake. Percutaneous cholecystotomy tube placement failed due to anatomy and antibiotics were initiated for treatment. A glomerulonephritis workup performed for new-onset hematuria revealed low C4 (10 mg/dL), positive ANA (1:320), elevated rheumatoid factor (202 mg/dL), MPO >740, Ro52, Ro60 and SSA/SSB were also positive. An urgent kidney biopsy showed pauci-immune crescentic glomerulonephritis consistent with MPO positive ANCA vasculitis. Treatment included pulse dose steroids, followed by a prednisone taper, five sessions of plasmapheresis, two dose of intrravenous cyclophosphamide and rituximab 1000 mg for two doses. During induction therapy her abdominal pain completely resolved, and further abdominal imaging was negative favoring gallbladder involvement was related to vasculitis.
Discussion
This case highlights a unique presentation of biopsy-proven AAV manifesting as acute cholecystitis with concurrent RPGN. GI manifestations of AVV most commonly mimic gastritis or inflammatory bowel disease. Gallbladder involvement is even rarer with literature confined to case reports. Further studies examining the prevalence and associated factors would help characterize this population and potentially avoid unneeded surgeries.