Case Report

Granulomatosis with Polyangiitis Presenting as Pyrexia of Unknown Origin, Leukocytosis, and Microangiopathic Haemolytic Anemia

Figure 1

Relationship between serum creatinine, WBC, and haemoglobin. Upon initial presentation to our hospital several months earlier, patient had normal laboratory values. At this admission the patient had leukocytosis, anemia, and rising creatinine values. Administration of methylprednisolone and rituximab (star) was associated with an initial rise in WBC count. Within several days leukocyte counts began to decline, most notably after the second rituximab infusion (two stars). Haemoglobin and creatinine levels also responded appropriately. At the outpatient clinic follow-up the patient received another two doses of rituximab. Laboratory testing continued to show improved WBC count, haemoglobin, and creatinine levels.