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Microscopic polyangiitis — SCE Rheumatology MCQ

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HardVasculitisMicroscopic polyangiitisSCE Rheumatology

A 66-year-old woman has haematuria, proteinuria and progressive dyspnoea. CT chest shows diffuse alveolar haemorrhage without nodules, MPO-ANCA is positive and renal biopsy shows pauci-immune necrotising crescentic glomerulonephritis. There is no asthma or ENT disease. What is the most likely diagnosis?

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Correct answer: A — Microscopic polyangiitis

Pulmonary-renal syndrome with MPO-ANCA and pauci-immune crescentic GN without granulomatous ENT disease is typical of microscopic polyangiitis. EGPA would usually include asthma and eosinophilia. PAN does not cause glomerulonephritis because it affects medium vessels rather than capillaries.

Reference: BSR ANCA-associated vasculitis recommendations 2025; EULAR AAV recommendations