Abstract: FR-PO0753
From Hallucinations to Multiorgan Failure: A Fulminant Presentation of Myeloperoxidase (MPO)-ANCA-Associated Vasculitis
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
- Mannam, Hari Priya Sri Sai, The University of Kansas School of Medicine, Wichita, Kansas, United States
- Chan, Wan-Chi, The University of Kansas School of Medicine, Wichita, Kansas, United States
- Kadhem, Salam, Kansas Nephrology Physicians, Wichita, Kansas, United States
Introduction
MPO-ANCA–associated vasculitis is a systemic necrotizing small-vessel vasculitis classically presenting with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage (DAH), and systemic inflammation. CNS involvement occurs in 10–15% of cases. Visual hallucinations as a presenting feature are exceedingly rare, risking misattribution to neurodegenerative or metabolic etiologies in elderly, comorbid patients.
Case Description
A 73-year-old male with CAD, type 2 diabetes, prior stroke, and hypertension presented with vivid visual hallucinations of deceased individuals, progressive weakness, recurrent falls, and dyspnea after antibiotic-treated pneumonia. BP was 195/98 mmHg; hemoglobin 8.2 g/dL (from 10.7 g/dL); AKI, BNP 377 pg/mL, and multifocal pulmonary opacities were noted. Urinalysis revealed nephrotic-range proteinuria and hematuria. MPO-ANCA serology was positive; kidney biopsy confirmed crescentic glomerulonephritis. MRI identified multifocal embolic infarcts consistent with CNS vasculitis. Bronchoscopy confirmed DAH; the patient progressed to ARDS requiring intubation and prone positioning. New seizures and ischemic strokes emerged. Despite corticosteroids, rituximab, cyclophosphamide, and plasmapheresis, he developed refractory volume overload and escalating respiratory failure. CRRT was initiated for non-recovering AKI. The patient progressed to multiorgan failure; the family elected hospice and he passed away.
Discussion
Visual hallucinations initially prompted consideration of Lewy body dementia, metabolic encephalopathy, and cerebrovascular disease. Recognition of the concurrent renal-pulmonary-neurologic constellation redirected evaluation toward systemic vasculitis. The fulminant pulmonary-renal syndrome with CNS vasculitis carries exceptionally high mortality. Corticosteroids with rituximab or cyclophosphamide represent standard induction; plasmapheresis was added for severe organ involvement, though long-term renal benefit remains debated.
MPO-ANCA vasculitis may debut with neuropsychiatric symptoms—including visual hallucinations—obscuring the diagnosis. Concurrent renal dysfunction, treatment-refractory pulmonary infiltrates, and neurologic decline should prompt urgent ANCA evaluation. Prognosis in fulminant multiorgan disease is poor despite maximal therapy. Early recognition, multidisciplinary intervention, and timely goals-of-care discussions are essential.
Acknowledgment
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