LAUSR

A 71-year-old woman was admitted to our hospital complaining of fever, headache, and stiffness affecting the neck and shoulders for 2 weeks. Laboratory data were as follows: white blood cell count 11,700/μL, C-reactive protein 19.3 mg/dL, erythrocyte sedimentation rate 102 mm, creatinine 2.04 mg/dL, and myeloperoxidase (MPO) anti-neutrophil cytoplasmic antibody (ANCA) 120 U/mL (normal level, < 3.5 U/mL). Because induration of the temporal artery was palpable, temporal artery biopsy was performed. Inflammatory cell infiltration was identified in the vascular wall (Fig. 1a). Necrotizing arteritis was found in the branches, accompanied by giant cells (Fig. 1b). A diagnosis of giant cell arteritis was made. Renal biopsy demonstrated necrotizing crescentic glomerulonephritis (Fig. 2a, b). In addition, venulitis with perivascular inflammatory infiltrates and giant cells (Fig. 2c), and necrotizing vasculitis in small arteries were observed (Fig. 2d). Therefore, this vasculitis appeared to be associated with MPO-ANCA [1]. Oral prednisolone improved her renal function and symptoms.