ANCA seropositivity in HIV: a serological pitfall

Neth J Med. 2005 Jul-Aug;63(7):270-4.

Abstract

In systemic vasculitis, cytoplasmic staining in ethanol-fixed neutrophilic granulocytes, i.e. cytoplasmic antineutrophilic cytoplasmic antibody (c-ANCA), is generally considered a highly significant serological marker. When a patient presents with upper airway or renal symptomatology and seropositivity to c-ANCA, a Wegener's granulomatosis is usually easily diagnosed by performing a biopsy of the diseased organ. However, not every ANCA-positive patient with pulmonary inflammation is suffering from Wegener's disease. In some cases of upper airway or pulmonary symptomatology, the a priori chance of having Wegener's disease is low despite a positive ANCA. A coincidental positivity of ANCA may then lead to clinicians jumping to conclusions. We present a 40-year-old man who was falsely suspected of having Wegener's disease because of upper airway symptomatology and c-ANCA positivity. Specificity analysis revealed that he was negative to antibodies for proteinase-3, but positive to myeloperoxidase. The potential serological pitfall of the supposedly specific c-ANCA is discussed.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Antineutrophil Cytoplasmic / immunology*
  • Diagnosis, Differential
  • False Positive Reactions
  • Fluorescent Antibody Technique, Indirect
  • Granulomatosis with Polyangiitis / blood
  • Granulomatosis with Polyangiitis / diagnosis
  • Granulomatosis with Polyangiitis / immunology
  • HIV Seropositivity / blood
  • HIV Seropositivity / diagnosis*
  • HIV Seropositivity / immunology
  • Humans
  • Male
  • Radiography, Thoracic

Substances

  • Antibodies, Antineutrophil Cytoplasmic