Mrs VD a 56 year old female presented to ER with complaints of fever for 3 months and mild renal dysfunction. She had past history of hypertension and no other comorbidities.

Initial urine culture was suggestive of E coli while she turned out to be negative for typhoid, malaria and CECT chest and abdomen was also inconclusive.

She was started on antibiotics according to culture sensitivity reports. There was a progressive rise in serum creatinine.As the response was inadequate and creatinine was rising she was evaluated further and underwent one session of haemodialysis also. On further evaluation urine routine showed proteinuria and microscopic haematuria along with positive report of pANCA. Meanwhile PET scan and bone marrow evaluation was negative for malignancy. She underwent kidney biopsy during her admission which was suggestive of cresentric glomerulonephritis which was negative for IgG, IgA, C3, kappa and lambda chains.

Final diagnosis of ANCA associated glomerulonephritis with rapidly progressive glomerulonephritis was made. She was started on steroids and cyclophosphamide and later on shifted to Azathioprine. She has shown good response to treatment and at present she has normal renal functions.