2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Research Snapshot Theater: Neuroscience, Adult VII

Non-Aneurysmal Subarachnoid Hemorrhage as a Presentation of Undiagnosed Microscopic Polyangiitis

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 09
  • MJ

    Manavi Johri, MD (she/her/hers)

    Florida

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • AJ

    Amer Jarri, MD

    Fellow Physician
    USF Morsani College of Medicine/HCA Bayonet Point Hospital

    Disclosure information not submitted.

  • RR

    Rohit Rangroo, MD

    Fellow Physician
    USF Morsani College of Medicine/HCA Bayonet Point Hospital

    Disclosure information not submitted.

  • RP

    Robin Paudel, MD

    Attending Physician
    USF Morsani College of Medicine/HCA Bayonet Point Hospital

    Disclosure information not submitted.

Introduction: Anti-neutrophil cytoplasmic antibody–associated vasculitides (ANCA-AAV), such as microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis, predominantly affect small vessels and can involve the kidneys, lungs, and peripheral nerves. Central nervous system (CNS) involvement is uncommon; subarachnoid hemorrhage (SAH), particularly due to p-ANCA–associated vasculitis, is exceedingly rare.


Description: We report a case of a 52-year-old woman with untreated systemic lupus erythematosus (SLE) who presented with sudden-onset severe headache and vomiting. She was hypertensive and somnolent, without focal neurological deficits. Laboratory workup revealed acute kidney injury (creatinine 3.2 mg/dL) and significant proteinuria (urine protein/creatinine ratio 23.83). Head CT showed SAH (Hunt and Hess grade 2, Fisher grade 4). CT angiography revealed no aneurysms, suggesting a non-aneurysmal etiology.
Her mental status subsequently declined, and she developed hydrocephalus requiring placement of an external ventricular drain. She also developed hypoxia and hemoptysis; bronchoscopy confirmed diffuse alveolar hemorrhage. Serology revealed a positive antinuclear antibody, elevated p-ANCA (8.0 antibody index), normal complement levels, and negative anti–double-stranded DNA. Renal biopsy demonstrated pauci-immune crescentic glomerulonephritis with fibrinoid necrosis, confirming MPA. She was treated with high-dose methylprednisolone and plasmapheresis. Despite this, she developed severe ARDS requiring intubation. Chest CT demonstrated bilateral ground-glass opacities. Rituximab and IV Immunoglobulin were initiated, but her condition continued to worsen. Care was transitioned to comfort measures, and she passed away in hospice.


Discussion: CNS involvement in AAV occurs in approximately 7–10% of cases, usually as ischemic stroke or intracerebral hemorrhage. Non-aneurysmal SAH is particularly rare in p-ANCA vasculitis. This case mirrors others in the literature describing SAH due to small-vessel fragility. Though SLE broadened the differential diagnosis, biopsy and serology supported a primary diagnosis of AAV. This case underscores the need to consider vasculitis in angiography-negative SAH, especially in patients with systemic manifestations such as renal or pulmonary involvement.