The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Patients with Large-Vessel Abnormalities Present Diagnostic Dilemma for Rheumatologists

Patients with Large-Vessel Abnormalities Present Diagnostic Dilemma for Rheumatologists

February 1, 2015 • By Eli Miloslavsky, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
In this case, severe abdominal pain was one of the patient’s presenting symptoms.
In this case, severe abdominal pain was one of the patient’s presenting symptoms.

Presentation

BF, a 43-year-old man with a history of attention deficit hyperactivity disorder (ADHD) and bipolar disorder, was in his usual state of excellent health until March 2014, when he experienced sudden onset of severe, sharp, left-sided abdominal pain radiating to the groin. The pain resolved after an hour, but recurred five times over the next week. Each episode was longer in duration, which prompted him to present to the emergency department of another hospital. He did not experience fevers, chills, night sweats, oral or genital ulceration, rash, visual changes, sinus symptoms, dyspnea, hematuria, or extremity weakness or numbness. His medications included lamotrigine without recent changes. His family and social histories were unremarkable.

You Might Also Like
  • New Recommendations Guide Imaging in Large-Vessel Vasculitis
  • New Large-Vessel Vasculitis Therapies Emerge, but Better Options Still Needed
  • New Study Aimed at Better Predicting Large Vessel Vasculitis Relapse
Explore This Issue
February 2015
Also By This Author
  • Case Study: 66-Year-Old Man with Visual Loss, Headache, Hematuria, Chronic Sinusitis

On exam at the other hospital, he was afebrile and normotensive, with diffuse abdominal tender­ness without guarding or rebound. Laboratory workup revealed a normal complete blood count, serum creatinine and urinalysis. Erythrocyte sedimentation rate (ESR) was 54 mm/hr (ref. <13 mm/hr) and

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

the C-reactive protein (CRP) was 5 mg/dL (ref. <0.5 mg/dL). A CT of the abdomen with oral and intravenous contrast was performed, which revealed a long left renal artery dissection with surrounding fat stranding, multiple left renal infarcts (see Figure 1) and dissections of both common and right external iliac arteries (see Figure 2). The right common iliac artery was noted to have surrounding soft tissue thickening. A CT angiogram of the chest did not demonstrate any abnormalities of the aorta or the great vessels.

In the absence of signs & symptoms suggestive of a specific etiology, the clinician must rely on inflammatory markers & imaging to make the diagnosis.

He was started on prednisone 40 mg twice daily and admitted to the other hospital. Further laboratory testing revealed negative anti-nuclear cytoplasmic antibody (ANCA), anti-nuclear antibody (ANA), cryoglobulins and a normal reaction to purified protein derivative (PPD). Complements, hepatitis B and C serologies, as well as a toxicology panel were also normal. His abdominal pain resolved during admission. A presumptive diagnosis of a large-vessel vasculitis was made.

Over the next month, he did not have recurrent abdominal pain and prednisone was decreased to 20 mg twice daily. A CT repeated six weeks after initial imaging revealed that the left common iliac dissection had extended into the aorta, with surrounding inflammatory changes. Fat stranding and soft tissue thickening surrounding the right common iliac and left renal artery had improved. His prednisone dose was increased to 60 mg daily, and he was referred to the rheumatology clinic at our hospital for evaluation.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 | Single Page

Filed Under: Conditions, Meeting Reports, Vasculitis Tagged With: AC&R, Annual Meeting, Association of Rheumatology Professionals (ARP), Award, Lupus Foundation, Research, rheumatology, Salmon, TsokosIssue: February 2015

You Might Also Like:
  • New Recommendations Guide Imaging in Large-Vessel Vasculitis
  • New Large-Vessel Vasculitis Therapies Emerge, but Better Options Still Needed
  • New Study Aimed at Better Predicting Large Vessel Vasculitis Relapse
  • Large-Vessel Involvement Is an Independent Risk Factor Predicting GCA Mortality

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)