Abstract |
A 57-year-old holidaymaker in Madeira was airlifted to England with a 4-week history of fever, limb weakness and hypophonia. Having undergone a range of investigations during his hospital admission abroad - including ultrasound, CT, echocardiogram and lumbar puncture - the patient arrived without any explanatory diagnosis. At presentation, the only investigatory positives were raised blood inflammatory markers and a, previously unidentified, 'old left frontal infarct' found on head CT. A broad infective and immunological screen proved negative, raising the possibility of vasculitis. Finally, the presence of subacute cerebral and renal infarcts identified on MRI and CT in combination with a negative antineutrophil cytoplasmic antibodies ( ANCA) test and distinctive muscle biopsy features confirmed the clinical suspicion of polyarteritis nodosa. An immunosuppressive regime of glucocorticoid therapy and cyclophosphamide were initiated with immediate significant clinical improvement.
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Authors | Chun Lap Pang, Peter Richardson, Damodar Makkuni |
Journal | BMJ case reports
(BMJ Case Rep)
Vol. 2012
(Jul 09 2012)
ISSN: 1757-790X [Electronic] England |
PMID | 22778463
(Publication Type: Case Reports, Journal Article)
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Topics |
- Arteries
(pathology)
- Biopsy
- Diagnosis, Differential
- Fever of Unknown Origin
(diagnosis, etiology)
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Muscle, Smooth, Vascular
(pathology)
- Polyarteritis Nodosa
(complications, diagnosis)
- Tomography, X-Ray Computed
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