Pleural vasculitides of microscopic polyangiitis with asbestos‐related plaques

A 69‐year‐old man who had been exposed to asbestos for approximately 40 years presented with the complaint of fever and pleuritic chest pain on the right side on deep inspiration. Chest X‐ray films showed pleural effusion in the right side. Initial antibiotic treatment was ineffective. The hyaluronic acid level was high in the pleural effusion but no malignant mesotheliomal cells were seen with blind pleural biopsy. Blood chemistry showed a remarkable high titer of myeloperoxidase anti‐neutrophil cytoplasmic antibody (MPO‐ANCA) and open renal biopsy suggested crescentic glomerulonephritis. The precise pathological examination on the pleura obtained by the open pleural biopsy showed vasculitides and plaque leading to diagnosis of microscopic polyangiitis (MPA). This is a rare case of MPA seen in the pleural arteries. This is a rare case of microscopic polyangiitis (MPA) in the pleural arteries in a 69 year old man with a 40 years history of asbestos exposure. The patient presented with fever and right side pleuritic chest pain on deep inspiration. Right side pleural effusion contained high levels of hyaluronic acid level but no malignant mesotheliomal cells. Blood MPO‐ANCA were high and open renal biopsy suggested crescentic glomerulonephritis. Precise pathological examination on the pleura showed vasculitides and plaque leading to diagnosis of MPA.