Computerized interstitial fibrosis quantification is the most powerful histological predictor of renal outcome in ANCA-associated vasculitis

We report the case of a 62-year-old woman with rheumatoid arthritis treated with adalimumab, an anti–tumor necrosis factor α drug, who presented with 4 weeks of lethargy, upper respiratory tract symptoms, a vasculitic skin rash, and rapidly deteriorating renal function. She had cytoplasmic antineutrophil cytoplasmic antibodies and skin and renal biopsy specimens diagnostic of small vessel vasculitis and necrotizing crescentic glomerulonephritis, respectively. After immunosuppressive therapy and discontinuation of adalimumab therapy, vasculitis resolved and renal function recovered. This is the first report of antineutrophil cytoplasmic antibody associated necrotizing glomerulonephritis with adalimumab.