A fatal case of ANCA-associated vasculitis resulting in multiple organ failure: Case report and literature review

BACKGROUND: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) may progress rapidly to multi-organ failure. CASE: An 89-year-old woman with diabetes, atrial fibrillation (on rivaroxaban), and chronic kidney disease presented with hemoptysis and respiratory failure. Initially managed as pneumonia, she developed diffuse alveolar hemorrhage, acute kidney injury, and liver dysfunction. p-ANCA positivity confirmed AAV, but immunosuppressive therapy was deferred due to septic shock. Despite aggressive supportive care, she died from multi-organ failure on day 12. CONCLUSION: AAV should be considered in elderly patients with hemoptysis and rapid multi-organ deterioration. Early diagnosis and cautious immunosuppressive use are essential for improving outcomes.