Rare presentation of granulomatosis with polyangiitis.
Diagnosis, Differential
Fingers
/ pathology
Gangrene
/ drug therapy
Granulomatosis with Polyangiitis
/ complications
Humans
Immunologic Factors
/ therapeutic use
Male
Methylprednisolone
/ therapeutic use
Middle Aged
Raynaud Disease
Rituximab
/ therapeutic use
Stroke
/ etiology
Toes
/ pathology
Treatment Outcome
rheumatology
vasculitis
Journal
BMJ case reports
ISSN: 1757-790X
Titre abrégé: BMJ Case Rep
Pays: England
ID NLM: 101526291
Informations de publication
Date de publication:
22 Feb 2019
22 Feb 2019
Historique:
entrez:
25
2
2019
pubmed:
25
2
2019
medline:
6
6
2019
Statut:
epublish
Résumé
A 62-year-old man with no pertinent medical history presented with lower extremity weakness and worsening distal fingertips and toe cyanosis/gangrene. In the outpatient setting, he was initially being treated for Raynaud's phenomenon with a calcium channel blocker. On presentation, the patient had elevated inflammatory markers and white blood cell count. Serum vasculitis panel (proteinase-3 antibody) supported the diagnosis of granulomatosis with polyangiitis. His hospital course was complicated by ischaemic stroke and a diagnosis of mononeuritis multiplex in his lower extremities. After initiating therapy with intravenous steroid and rituximab, his symptoms overall improved including cyanotic fingertips/toes. His inflammatory markers and leucocytosis also improved. Outpatient follow-up consisted of further rituximab infusions and unrelated umbilical hernia incarceration which required surgery. He was found incidentally to have subsegmental pulmonary emboli which most likely occurred during the initial presentation prior to his diagnosis. The patient moved out of state and was lost to follow-up.
Identifiants
pubmed: 30798274
pii: 12/2/e227218
doi: 10.1136/bcr-2018-227218
pmc: PMC6441313
pii:
doi:
Substances chimiques
Immunologic Factors
0
Rituximab
4F4X42SYQ6
Methylprednisolone
X4W7ZR7023
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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