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Rinsho Shinkeigaku ; 63(1): 21-26, 2023 Jan 28.
Artigo em Japonês | MEDLINE | ID: mdl-36567102

RESUMO

A 72-year-old male complained of fever lasting 1 month and developed muscle weakness and paresthesia in the legs. He presented with muscle weakness, grasping pain, decreased deep tendon reflexes in the extremities, and reduction of tactile sensation in the distal parts of the left leg muscles. Blood tests revealed leukocytosis and inflammatory reactions. Collagen-disease-specific autoantibodies including anti-double-stranded DNA and anti-Scl-70 antibodies were positive, but antineutrophil cytoplastic antibodies were negative. Nerve conduction studies revealed asymmetric axonal degeneration, indicating multiple mononeuropathy. We started intravenous methylprednisolone pulse and plasma exchange therapies. However, the patient developed intestinal necrosis and perforation, and he died 44 days after the onset of fever. An autopsy revealed vasculitis in small- to medium-sized vessels in multiple organs as well as myoglobin casts in the renal tubules, which were suggestive polyarteritis nodosa (PAN) accompanied with rhabdomyolysis. Positivity for collagen-disease-specific autoantibodies and accompanying rhabdomyolysis are atypical findings with PAN. This patient was not clinically diagnosed as PAN, and so promptly starting immunotherapies should be considered when a case presents with evidence of vasculitis.


Assuntos
Poliarterite Nodosa , Rabdomiólise , Vasculite , Masculino , Humanos , Idoso , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico , Autopsia , Vasculite/complicações , Rabdomiólise/complicações , Autoanticorpos , Debilidade Muscular/complicações , Colágeno
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