Image in medicine
ANCA-associated vasculitis
Vasculitis asociada a ANCA
Sandro Herrera-Darias, Gilsy Guillén-Chirinos, Juan Manuel Gómez-Cerquera
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Servicio de Medicina Interna, Hospital General, Parc Sanitari de Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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Physical examination revealed right palpebral erythema with pain on eye movements, a single raised lesion on the hard palate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, arrow) and palpable purpura in the lower limbs. Pulmonary auscultation was normal. A chest X-ray showed bibasilar cotton-wool infiltrates (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B, arrow) and a chest CT scan showed extensive areas of ground glass opacity in the lower lobes compatible with alveolar haemorrhage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C, arrow). A brain MRI showed inflammatory signs in fat and right retro-ocular muscles compatible with an orbital pseudotumour (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D, arrow). CBC showed CRP of 124 mg/l and ESR of 37 mm/h. Normal renal function. Bronchoscopy showed traces of bleeding in the right bronchial tree. The autoimmunity study revealed highly positive anti-neutrophil cytoplasmic antibodies (ANCA) with anti-proteinase-3 (anti-PR3) specificity, concluding the diagnosis of granulomatosis with polyangiitis. Treatment with methylprednisolone boluses (500 mg per day for 3 days) and then a course of rituximab was indicated and the haemoptysis and skin lesions resolved.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">ANCA-associated vasculitides are a rare group of diseases, sometimes with unusual presentations, so their diagnosis is often delayed. Severe forms (such as diffuse alveolar haemorrhage) require high diagnostic suspicion and early treatment to decrease morbidity and mortality.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0015" class="elsevierStylePara elsevierViewall">The present study has followed all the protocols established in our institution for clinical research and has the informed consent of the patients involved.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research has not received specific support from public, commercial or non-profit entities.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1500 "Tamanyo" => 201046 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000010/v2_202311101432/S2387020623001626/v2_202311101432/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000010/v2_202311101432/S2387020623001626/v2_202311101432/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623001626?idApp=UINPBA00004N" ]
