Rationale: antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune syndrome characterized by necrotizing inflammation of small-to medium-sized vessels accompanied by the presence of peripheral blood ANCA. Subarachnoid hemorrhage (SAH) is an uncommon complication of AAV. The purpose of this report is to present a rare case of AAV complicated by SAH and to review the existing literature, thereby enhancing awareness of this severe neurological manifestation and its management strategies. Patient concerns: We report the case of a 56-year-old male who presented with cough, blood-tinged sputum, proteinuria, elevated serum creatinine levels, and headache. Laboratory examinations confirmed the presence of anti-myeloperoxidaseantibody, imaging revealed SAH, and angiography identified a ruptured anterior communicating artery aneurysm. Diagnoses: The final diagnosis was AAV complicated by SAH. Interventions: The patient underwent prompt endovascular coiling, with concurrent immunosuppression using methylprednisolone and intravenous cyclophosphamide. Outcomes: Following endovascular coiling, the patient’s subarachnoid hemorrhage and associated neurological symptoms (headache, dizziness) resolved completely. Immunosuppressive therapy led to the resolution of respiratory symptoms (cough and blood-tinged sputum), the clearance of hematuria, and a significant reduction in inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate. However, despite immunosuppressive treatment, with serum creatinine levels fluctuating between 320 and 450 μmol/L, and heavy proteinuria (e.g., 24-hour urine protein of 3360.21mg) persisted. Additionally, the patient developed deep vein thrombosis 1 month after discharge, which was successfully managed with anticoagulation therapy and the placement of an inferior vena cava filter. Lessons: SAH is a rare but life-threatening complication of AAV. Vigilance for acute neurological symptoms, such as headache, enables early intervention. Combined endovascular repair for SAH and immunosuppressive therapy significantly improve outcomes.
Dong et al. (Fri,) studied this question.