Anti-Citrulline Positive Pulmonary Vasculitis

Abstract

Objective: To describe a case of rapidly progressive pulmonary vasculitis, difficult to diagnose and manage therapeutically, in a previously healthy patient, whose autoimmune nature was confirmed by the positivity of anticitrulline antibody and antinuclear factor. Case Details: Patient, 34 years old, female, on the fifth day postpartum with fetal death, presenting with polyarthritis and fever syndrome, with elevated inflammatory markers, negative autoimmune panel, except for ANA and Anti-CCP, which progressed to Severe Acute Respiratory Distress Syndrome, requiring mechanical ventilation, unresponsive to pulse therapy with methylprednisolone and intravenous cyclophosphamide, and successful therapeutic outcome with Rituximab. Final Considerations: Anti-CCP positive pulmonary vasculitis, also called rheumatoid, is a rare complication, with no well-defined diagnostic criteria and no well-described treatment in the literature. For this reason, it is essential to share experiences regarding the diagnosis and management of non-ANCA-associated pulmonary vasculitis to contribute to improving the approach to similar cases and enrich the literature on the subject.