ABSTRACT
We report a case of a 76-year-old woman, presenting with a persistent dry cough, subfebrility, arthralgia and myalgia, weight loss and a breast lesion. She has elevated inflammatory parameters, impaired renal function with proteinuria, bilateral lung nodules on computed tomography scan (CT scan) and a suspect lesion on mammography. A diagnosis of microscopic polyangiitis with involvement of the breast is made based on clinical and radiographic findings, with positive auto-immune serology and histological confirmation. Although vasculitis of the breast is uncommon, this case illustrates that when a breast lesion is found, in combination with constitutional symptoms, we should think about the possibility of an anti-Neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. Therefore it may be important to perform auto-immune serology in these cases before proceeding to major surgery.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Breast Diseases/diagnosis , Breast , Microscopic Polyangiitis , Aged , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Azathioprine/administration & dosage , Azathioprine/adverse effects , Breast/blood supply , Breast/pathology , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Diagnosis, Differential , Drug Therapy, Combination , Female , Humans , Immunologic Factors/blood , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Mammography , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effects , Microscopic Polyangiitis/diagnosis , Microscopic Polyangiitis/drug therapy , Microscopic Polyangiitis/immunology , Microscopic Polyangiitis/physiopathology , Microvessels/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Brucellosis is a common zoonosis which still remains a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we report an uncommon case of spondylodiscitis due to Brucella in a male who presented with abdominal pain. The diagnosis was established by positron emission tomography combined with computed tomography (PET/CT scan) and magnetic resonance followed by a confirmation on Brucella-agglutination test and positive culture of computed tomography (CT) guided punction fluid. This case report illustrates an atypical presentation of spondylitis and points out the difficulties in diagnosing the aetiological agens Brucella and differentiating its specific features from tuberculosis.
