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

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.