Treatment of ANCA‐Associated Glomerulonephritis Complicated by Bacteremia and Vertebral Osteomyelitis: A Challenging Medical Situation

Bahjat Azrieh; Abdullah Thayyil; Mohamed Fawzi Mudarres; Nada Youssef; Naga Sumanth Gopireddy; Douglas Somers; Melissa Swee

doi:10.1155/crin/4392221

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Treatment of ANCA‐Associated Glomerulonephritis Complicated by Bacteremia and Vertebral Osteomyelitis: A Challenging Medical Situation

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Treatment of ANCA‐Associated Glomerulonephritis Complicated by Bacteremia and Vertebral Osteomyelitis: A Challenging Medical Situation

Bahjat Azrieh, Abdullah Thayyil, Mohamed Fawzi Mudarres, Nada Youssef, Naga Sumanth Gopireddy, Douglas Somers and Melissa Swee

Case reports in nephrology, Vol.2025(1), 4392221

10/15/2025

DOI: 10.1155/crin/4392221

PMCID: PMC12543596

PMID: 41133109

Appears in UI Libraries Support Open Access

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Abstract

Although the prognosis for patients with ANCA‐associated vasculitis (AAV) has improved with modern immunosuppressive drugs, treatment‐related complications continue to contribute significantly to morbidity and mortality. Infections, in particular, pose a major risk. Older age, high disease activity at diagnosis, and use of potent immunosuppressants are the most important prognostic factors. Older age is independently associated with mortality, severe renal failure, pulmonary hemorrhage, and relapse. This case highlights the challenge of balancing effective immunosuppression with the associated increased risk of infection. A 77‐year‐old male treated for MPO‐ANCA–positive crescentic glomerulonephritis developed severe complications, including bacteremia, osteomyelitis, and disseminated herpes zoster, ultimately resulting in septic shock. Emerging therapies such as avacopan and predictive tools such as the Death in ANCA Glomerulonephritis–Estimating the Risk (DANGER) score may help clinicians better navigate these complex scenarios by guiding treatment intensity and minimizing risks.

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Title: Subtitle: Treatment of ANCA‐Associated Glomerulonephritis Complicated by Bacteremia and Vertebral Osteomyelitis: A Challenging Medical Situation
Creators: Bahjat Azrieh - University of Iowa
Abdullah Thayyil - University of Iowa
Mohamed Fawzi Mudarres - University of Iowa
Nada Youssef - The University of Texas MD Anderson Cancer Center
Naga Sumanth Gopireddy - University of Iowa
Douglas Somers - University of Iowa
Melissa Swee - University of Iowa
Resource Type: Journal article
Publication Details: Case reports in nephrology, Vol.2025(1), 4392221
DOI: 10.1155/crin/4392221
PMID: 41133109
PMCID: PMC12543596
NLM abbreviation: Case Rep Nephrol
ISSN: 2090-6641
eISSN: 2090-665X
Publisher: Wiley
Language: English
Electronic publication date: 10/15/2025
Academic Unit: Pathology; Nephrology; Internal Medicine
Record Identifier: 9985014816402771

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