Anemia in a Super-elderly Patient With Pelvic Fracture Complicated by Bacterial Translocation and Suspected Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Case Report.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic inflammatory disorder that may present with diverse clinical manifestations, including anemia of inflammation. We report the case of a 102-year-old woman who developed rapidly progressive anemia following a pubic fracture complicated by vascular injury. She presented with impaired mobility after a fall and was admitted for orthopedic management. During hospitalization, progressive anemia and fever were observed, prompting further evaluation. Imaging demonstrated a hematoma adjacent to the fracture site and ascites, raising suspicion of intra-abdominal infection. Laboratory studies excluded iron, vitamin B12, and folate deficiency, but ferritin was markedly elevated, suggesting anemia of inflammation. Empirical antibiotics were initiated for suspected bacterial translocation, resulting in clinical improvement. Additional evaluation revealed cytoplasmic-positive antinuclear antibody, elevated myeloperoxidase ANCA, and proteinuria, raising the possibility of ANCA-associated vasculitis as an inflammatory contributor. Due to her advanced age, invasive diagnostic procedures were not performed. Supportive management with transfusion and oral iron supplementation was combined with corticosteroid therapy, which led to improvement in hemoglobin and reduction in ferritin levels. She was subsequently transferred to a rehabilitation ward with the goal of eventual home discharge. This case highlights the diagnostic challenges of anemia in the super-elderly and underscores the need for pragmatic management when invasive investigations are not feasible.