Digital infarct and mononeuritis in a middle aged female: always suspect Antineutrophil cytoplasmic antibodies associated vasculitis

Authors

  • Avirup Majumdar Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Virendra Atam Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Saurabh Pandey Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Prashant Singh Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Himanshu Chauhan Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20201127

Keywords:

Antineutrophil cytoplasmic antibody vasculitis, Digital gangrene, Digital infarct, Mononeuritis multiplex

Abstract

Vasculitis is a process caused by inflammation of blood vessel walls and results in a variety of disorders.  Small-vessel vasculitis (vasculitis involving arteries, venules and capillaries) should be suspected in any patient who presents with a multisystem disease that is not caused by an infectious or malignant process. Testing for Antineutrophil cytoplasmic antibody (ANCA) is the basis of classification of small vessel vasculitis into ANCA associated and non - ANCA associated vasculitis. Apart from cutaneous manifestations like palpable purpura and vasculitic urticaria, digital gangrene in a patient with evidence of mononeuritis multiplex is highly suggestive of ANCA associated vasculitis (AAV). Clinically most of these vasculitides have overlapping clinical presentations and similar treatment. Early diagnosis and rapid initiation of treatment of AAV is recommended rather than ordering for definitive tests (e.g. histopathology or angiograms) since delay in treatment can result in serious end organ damage (pulmonary or renal).

References

Geetha D, Jefferson JA. ANCA-Associated Vasculitis: Core Curriculum 2020. Am J Kidney Dis. 2019 Jul 26.

Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med. 1997;337:1512-23.

Mansi IA, Opran A, Rosner F. ANCA-associated small-vessel vasculitis. Am Family Physician. 2002 Apr 15;65(8):1615.

Downloads

Published

2020-03-21