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2.
Intern Med ; 52(19): 2253-7, 2013.
Article in English | MEDLINE | ID: mdl-24088762

ABSTRACT

The classification of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has limitations because the condition includes disorders with similar general clinical features, similar characteristics of lung and renal involvement and a positive ANCA serology. A 40-year-old woman was admitted to our hospital for hemoptysis and dyspnea. She had no history of bronchial asthma. Laboratory examinations revealed hypereosinophilia, positive anti-myeloperoxidase antibodies, hematuria and proteinuria. The patient was ultimately diagnosed with AAV associated with diffuse alveolar hemorrhage, rapidly progressive glomerulonephritis and hypereosinophilia without bronchial asthma. Obtaining a definitive diagnosis of ANCA vasculitis can be very difficult, and the characteristics of this case were not compatible with the findings of typical AVV. We herein report a rare case of AVV.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Disease Progression , Glomerulonephritis/diagnosis , Hemorrhage/diagnosis , Hypereosinophilic Syndrome/diagnosis , Pulmonary Alveoli/pathology , Adult , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/blood , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Female , Glomerulonephritis/blood , Glomerulonephritis/complications , Hemorrhage/blood , Hemorrhage/complications , Humans , Hypereosinophilic Syndrome/blood , Hypereosinophilic Syndrome/complications
3.
Heart Vessels ; 27(2): 216-20, 2012 Mar.
Article in English | MEDLINE | ID: mdl-21655903

ABSTRACT

Giant cell arteritis involving intramural coronary artery branches is rare, and its clinical features remain poorly understood. We report a 56-year-old hemodialysed patient with a history of mitral valve replacement, who presented with "fever of unknown origin" and intractable hypotension. The antemortem diagnosis was very difficult and the autopsy revealed giant-cell-rich vasculitis in arteries in multiple organs. The heart was most severely involved, in which almost all of the intramural coronary artery branches were infiltrated by many multinucleated giant cells, macrophages, and lymphocytes with luminal narrowing, but the epicardial segments of the coronary arteries were spared. Superimposed on the preexisting valvular heart disease, the vasculitic lesions were thought to play a central role in severe cardiac dysfunction resulting in dialysis-related hypotension, which led to fatal non-occlusive mesenteric ischemia. This case highlights the possibility that giant cell arteritis of intramural coronary arteries could be an uncommon underlying cause of refractory dialysis-related hypotension.


Subject(s)
Coronary Artery Disease/complications , Giant Cell Arteritis/complications , Hypotension/etiology , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Autopsy , Coronary Artery Disease/pathology , Coronary Vessels/pathology , Fatal Outcome , Female , Fever of Unknown Origin/etiology , Giant Cell Arteritis/pathology , Humans , Ischemia/etiology , Kidney Failure, Chronic/complications , Mesenteric Ischemia , Middle Aged , Vascular Diseases/etiology
4.
J Neurosurg ; 100(3 Suppl Spine): 284-6, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15029917

ABSTRACT

The authors report on two patients undergoing long-term hemodialysis in whom cervical myelopathy was caused by calcification related to the cervical dural sac. The lesions were demonstrated on plain computerized tomography (CT) scans as dotted curvilinear bands outlining the dural sacs in almost the whole of their cervical spines. During posterior decompressive surgery in both cases, the CT scanning--documented curvilinear bands were identified as calcified plaques infiltrating the fibrous membranes beneath the ligamenta flava, constricting the cervical dural tube. In each case, the spinal cord could not be decompressed by merely enlarging the osseous spinal canal; rather, it required removal of the calcified membrane from the posterior surface of the dura. Based on the operative findings, the lesion should be described as cervical peridural calcification.


Subject(s)
Calcinosis/etiology , Calcinosis/surgery , Dura Mater , Renal Dialysis/adverse effects , Spinal Cord Diseases/etiology , Spinal Cord Diseases/surgery , Aged , Calcinosis/diagnosis , Calcinosis/pathology , Cervical Vertebrae , Decompression, Surgical , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/pathology , Tomography, X-Ray Computed
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