Lanerolle, Email: moc.liamtoh@lakihsur.. with acute parenchymal changes and slight ascites. Her renal biopsy showed renal parenchyma comprising 20 glomeruli showing diffuse proliferative glomerular nephritis, with 14 of 20 glomeruli showing cellular crescents, and the result of Congo reddish staining was bad. Her rheumatoid element was positive with a high titer (120?IU/ml), but results for antinuclear antibody, double-stranded deoxyribonucleic acid, and antineutrophil cytoplasmic antibody (perinuclear and cytoplasmic) were negative. Antistreptolysin O titer 200 U/ml and cryoglobulins were not recognized. The results of her hepatitis serology, retroviral screening, and malignancy screening were bad. Her erythrocyte sedimentation rate was 110?mm in the 1st hour, and her C-reactive protein level was 45?mg/dl. Her liver profile showed hypoalbuminemia of 28?g/dl. Blasticidin S She was treated with immunomodulators and experienced a good Blasticidin S recovery of her renal function. Conclusions This case illustrates a rare demonstration of antineutrophil cytoplasmic antibody-negative crescentic glomerular nephritis in a patient with rheumatoid arthritis, awareness of which would facilitate early appropriate investigations and treatment. Antinuclear antibody, Antineutrophil cytoplasmic antibody, Antistreptolysin O titer, C-reactive protein, Double-stranded deoxyribonucleic acid, Erythrocyte sedimentation rate, Human immunodeficiency disease, High-power field A analysis of crescentic glomerular nephritis was made. The patient was started on atorvastatin, enalapril, and diuretics. Intravenous methylprednisolone 1?g was given for 3 consecutive days, followed by 1?mg/kg oral prednisolone. She was started on intravenous cyclophosphamide 500?mg every 2?weeks for a total of six doses. She gradually experienced increasing urine output and was symptomatically better, with improving renal function. Her serum creatinine level was 110?mol/L at her last medical center check out after 3?months Blasticidin S of treatment. Conversation A middle-aged female with seropositive rheumatoid arthritis presented to our hospital with gradually worsening generalized edema with features of intravascular volume overload. Investigations exposed a subnephrotic range of proteinuria with active sediment and impaired renal function with histological evidence of crescentic glomerular nephritis. Because crescentic glomerular nephritis is definitely a rare entity in Blasticidin S rheumatoid nephropathy, we looked for other causes of crescentic glomerular nephritis. Our individual did not possess clinical features of systemic vasculitis. Her antibody profile was bad for systemic lupus erythematosus, medium-vessel vasculitis, and cryoglobulinemia. Also, the result of her solid organ malignancy screening was bad. She was treated with methylprednisolone and cyclophosphamide pulses and experienced good recovery of her renal function. Crescentic glomerulonephritis is definitely a hardly Rabbit Polyclonal to STK17B ever explained entity [11C13]. These individuals generally present with microscopic hematuria, proteinuria, and renal impairment, as seen in our individual. It is usually associated with seropositive erosive disease having a median period of arthritis of 12?years (range 1C25 years) . However, our patient offered within 1?yr of receiving her seropositive rheumatoid arthritis diagnosis and did not have erosive arthritis. To the best of our knowledge, only one case of rheumatoid arthritis-associated ANCA-negative crescentic glomerular nephritis has been reported to day . Crescentic glomerular nephritis needs aggressive treatment with immunomodulators, including intravenous methylprednisolone pulses and cyclophosphamide . Conclusions Crescentic glomerular nephritis without systemic vasculitis as an extra-articular manifestation in rheumatoid arthritis is rare but has severe clinical manifestations. Early analysis and treatment are vital. Acknowledgements Not relevant. Funding Not relevant. Availability of data and materials Not applicable. Authors contributions RDL was the primary physician (specialist nephrologist) who cared for the patient. KB and LDSUS were involved in patient care and contributed academically. KB published the manuscript. RDL critically revised the manuscript. All authors go through and authorized the final manuscript. Competing interests The authors declare that they have no competing interests. Consent for publication Written educated consent was from the patient for publication of this case statement. A copy of the written consent is available for.