RESUMEN
We discuss the case of a 45-year-old male with complaints of abdominal pain, loose stools with on and off melena, and multiple joint pains bilaterally. The patient reported having similar episodes in the past, with slight variations in the symptoms and relief with short courses of steroids. Initially, a workup was done to identify an infectious etiology of the diarrhea. However, no such cause was identified. Similarly, an autoimmune profile was ordered to investigate the patient's joint complaints, albeit with no conclusive findings. His renal function tests and urinalysis showed findings indicative of an acute kidney injury. This prompted an antineutrophil cytoplasmic antibody (ANCA) profile, which was positive for c-ANCA. A diagnosis of granulomatosis with polyangiitis (GPA) was made, and the patient was started on pulse steroid and immunomodulator therapy with improvement in the patient's condition. This case is atypical due to its involvement of the gastrointestinal system, which is relatively rare, as well as polyarthritis of the small joints.
RESUMEN
We discuss the case of a 60-year-old male who presented with ankle pain, a necrotic rash, and progressive weakness in both lower limbs and the right upper limb. An infectious workup of the skin lesions came back negative. Additionally, his kidney function tests indicated an acute kidney injury. This prompted investigations for vasculitis etiologies, which revealed a positive cytoplasmic antineutrophil cytoplasmic autoantibody (c-ANCA). His neurological deficits were also investigated, and imaging suggested embolic infarcts. Cardiac imaging showed valve vegetations and blood culture showed a lack of growth suggestive of a noninfective nature of these lesions. Based on all these findings, a kidney biopsy was obtained and demonstrated pauci-immune segmental vasculitis consistent with ANCA-associated glomerulonephritis. As such, the patient showed improvement with heavy pulse steroid and immunomodulator therapy. Although skin, heart, and CNS involvement have been previously reported with ANCA-associated vasculitis, it is rare, especially together, and can prove a diagnostic challenge. Therefore, it is important to consider vasculitis etiology in patients presenting similarly. In addition, this case highlights the overlapping clinical picture between infective endocarditis and vasculitis with valvular involvement, making differentiation between the two challenging.
