Autoimmune dysfunction and subsequent renal insufficiency in a collegiate female athlete: a case report.

OBJECTIVE: To present the case of a female collegiate basketball player who was diagnosed with Wegener granulomatosis of the eyes and immunoglobulin A (IgA) nephropathy.
BACKGROUND: A 19-year-old female collegiate basketball player presented to a rheumatologist, urologist, and nephrologist with severe eye pain and was diagnosed with Wegener granulomatosis and IgA nephropathy. At age 20, during routine follow-up testing, urine protein levels were found to be 3 times normal values (0-8 mg/dL), prompting the need for a kidney biopsy, which showed IgA nephropathy, another autoimmune disorder. DIFFERENTIAL DIAGNOSIS: Sinus infection, scleritis, lymphomatoid granulomatosis, Churg-Strauss syndrome, lupus erythematosus, general granulomatosis. TREATMENT: Initial assessment revealed signs and symptoms, particularly in the patient's eyes, consistent with a sinus infection and scleritis. Her corneas were examined by a specialist, who prescribed various medications, including prednisone, for the relief of symptoms. When the dosage of prednisone was reduced, symptoms returned. Further tests revealed the presence of anti-neutrophil cytoplasmic antibody, a protein associated with Wegener granulomatosis, which helped confirm the diagnosis. The following year, a routine urinalysis showed abnormal levels of protein in her urine. A kidney biopsy revealed that IgA nephropathy also was present. At the time of this case report, the athlete continues to be monitored by an ophthalmologist who specializes in Wegener granulomatosis, a rheumatologist, and a nephrologist. UNIQUENESS: This athlete presented with 2 rare autoimmune disorders at an early stage of life. The medications used to treat the disorders left the athlete fatigued on a daily basis. Additionally, she was placed on 3 immunosuppressant drugs, which increased her risk for further health complications, yet she was able to successfully compete in athletics at the collegiate level. No family history of renal disease or other autoimmune disorders was discovered, further adding to the complexity and uniqueness of this case.
CONCLUSIONS: Autoimmune disorders, such as Wegener granulomatosis, can present with a variety of common signs and symptoms. As athletic trainers, we encounter a host of unusual signs and symptoms; however, in cases such as this, further investigation into the cause of the chief complaints can go a long way toward restoring or managing an athlete's health. Excellent communication among the sports medicine team helped this athlete manage her potentially life-threatening condition while allowing her to remain active in her sport.