Microscopic polyangiitis with massive myocardial necrosis and diffuse pulmonary hemorrhage

Autor: Constantine A. Axiotis, William L. Thelmo, Luoquan Wang
Rok vydání: 2002
Předmět:
Zdroj: Virchows Archiv. 441:202-204
ISSN: 1432-2307
0945-6317
DOI: 10.1007/s00428-002-0632-y
Popis: Sir, we report a rare autopsy case of microscopic polyangiitis (MPA) with myocardial infarction (MI) and pulmonary hemorrhage. A 41-year-old black woman presented with recent onset of severe headache, arthralgia, myalgia, and chest pain. Physical examination revealed macular facial rash. No oral ulcers, photosensitivity, alopecia, weight loss, fever, or Raynaud’s phenomenon were present. Past medical history was unremarkable. The white blood count, hemoglobin, hematocrit, platelets, sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, creatinine, glucose, and liver enzyme studies were normal. The erythrocyte sedimentation rate (ESR) was 27 mm/h. The antinuclear antibody (ANA) titer was 1:2560 with a speckled pattern. Rheumatoid factor was negative. Creatine phosphokinase (CK) was 99 mU/ml. Her electrocardiogram (EKG) showed normal sinus rhythm. The patient was given 400 mg ibuprofen twice a day. One month later, her symptoms were not relieved and prednisone 15 mg/day was initiated by her primary care physician. There was no improvement. Prednisone was discontinued at the patient’s request. Three months later the patient was hospitalized due to dyspnea and chest pain of 5-day duration. Physical examination revealed bilateral basilar crepitations in the lungs. Cardiovascular and neurological examinations were insignificant. EKG and chest roentgenogram (CXR) were normal. There were no skin lesions or joint tenderness. Further immunological studies showed: ANA titer 1:1280; negative anti-double strand DNA, anti-ribonucleoprotein, anti-Smith, antineutrophil cytoplasmic antiantibody (ANCA), anti-SSA, anti-SSB, and anti-glomerular basement membrane (GBM) antibodies. Rapid plasma reagin was non-reactive. C3 and C4 were 103 mg/dl and 14.4 mg/dl, respectively. Prothrombin (PT) was 13.3 s and partial thromboplastin time (PTT) was 53.5 s. ESR was 27 mm/h. Urinalysis showed protein 100 mg/dl, red blood cells, and
Databáze: OpenAIRE
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