VANCA-associated vasculitis: a likely overlap with lupus?

ANCA-associated vasculitides are defined as necrotizing vasculitis with infiltration of neutrophils and monocytes in the vessel walls and characterized by the absence of immunoglobulin deposition (pauciimmune). They may be confused with Systemic Lupus Erythematosus (SLE) or may be superimposed on this disease. In this case report, the possible concomitance of an ANCA-associated vasculitis (granulomatosis with polyangiitis or GPA and microscopic polyangiitis or PAM) with SLE is shown. The patient opened the picture with cutaneous manifestations, arthralgias and arthritis, in addition to respiratory symptoms. She had renal dysfunction requiring hemodialysis, with a renal biopsy compatible with GPA, pauci-immune glomerulonephritis type, and alveolar hemorrhage. Furthermore, she was positive for the anti-dsDNA antibody suggesting the diagnostic possibility of SLE. The presented ANCA had an ANCA-p pattern, while the one expected in GPA would be ANCA-c. For this reason, microscopic polyangiitis (MPA) can also be considered as a possible diagnosis, given the similarities of manifestations. As for the overlap with SLE, its concomitance with GPA is known in the literature. Therefore, the probable final diagnosis of the condition presented was ANCA-p vasculitis with overlapping SLE.