Abstract: FR-PO0745
Infection-Related Glomerulonephritis Mimicking ANCA-Associated Vasculitis in a Patient with HIV and Multisystem Infection
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
- Loon, Jordan, Albany Medical Center, Albany, New York, United States
- Pal, Aman, Albany Medical Center, Albany, New York, United States
- Beers, Kelly, Albany Medical Center, Albany, New York, United States
Introduction
ANCA- associated vasculitis (AAV) requires treatment with high-dose immunosuppression, while infection-related glomerulonephritis (IRGN) requires treatment of the underlying infection. This can pose a significant therapeutic dilemma when there are overlapping diagnostic features.
Case Description
A 38 year-old male presented with hemoptysis, hypoxic respiratory failure, diarrhea, and dark urine. He was found to have an acute kidney injury with hematuria and nephrotic-range proteinuria (19.2g/day). Initial workup revealed newly diagnosed HIV (CD4 count 126) and multiple active infections including campylobacter jejuni, human metapneumovirus, syphilis, and chlamydia trachomatis. ANCA titres were weakly positive at 1:32. Antimicrobial and antiretroviral therapy were initiated. The most likely etiology was initially presumed to be IRGN due to his improving creatinine with infection treatment. He then developed worsening shortness of breath and increasing creatinine one week later. Kidney biopsy revealed diffuse crescentic glomerulonephritis with IgG/C3 co-dominant immune complex deposition and varying fibrosis, consistent with IRGN with features of superimposed AAV and possible HIV associated nephritis. Given his persistent hemoptysis and positive ANCA titres, the patient was initiated on high-dose corticosteroids and rituximab for suspected AAV. Bronchoscopy with lung biopsy was then performed and demonstrated no evidence of vasculitis. Immunosuppression was subsequently discontinued and his nephritis was ultimately attributed to infection, with continued improvement in kidney function.
Discussion
ANCA positivity and crescentic glomerulonephritis in the setting of active infection can create a diagnostic challenge. Infection can induce both ANCA seropositivity and glomerular injury difficult to distinguish from vasculitis on biopsy, which has been described in cases of infective endocarditis. In this patient, reliance on serology and renal pathology alone could have led to further immunosuppression in an already immunocompromised patient, highlighting the importance of multi-organ evaluation in diagnostically challenging cases.