Evangelatos Gerasimos, Fragoulis George E, Iliopoulos Alexios
Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece.
Mediterr J Rheumatol. 2020 Dec 28;31(4):412-415. doi: 10.31138/mjr.31.4.412. eCollection 2020 Dec.
We present a case of a 63-year old man with microscopic polyangiitis (MPA) in which the initial clinical presentation resembled the cranial form of giant cell arteritis (GCA) (headache, jaw claudication, low grade fever and raised inflammation markers). Ultrasound of both superficial common temporal arteries revealed signs indicative of vessel wall inflammation. Based on clinical picture and compatible imaging findings, treatment with corticosteroids for GCA was started. After initial improvement and steroid tapering, lung infiltrations, mononeuritis of the right peroneal nerve and cutaneous necrosis appeared and p-Antineutrophil cytoplasmic antibodies (ANCA) turned out to be positive. Three intravenous cyclophosphamide pulses for MPA led in disease remission and maintenance treatment with azathioprine followed. Two years later, the patient has no symptoms and laboratory parameters are normal. This case highlights that MPA can affect temporal arteries and can masquerade as cranial GCA.
我们报告一例63岁患有显微镜下多血管炎（MPA）的男性患者，其最初的临床表现类似于巨细胞动脉炎（GCA）的颅部型（头痛、颌部跛行、低热和炎症标志物升高）。双侧颞浅动脉超声显示有血管壁炎症的迹象。基于临床表现和相符的影像学检查结果，开始使用糖皮质激素治疗GCA。在最初病情改善和激素减量后，出现了肺部浸润、右腓总神经单神经炎和皮肤坏死，且抗中性粒细胞胞浆抗体（ANCA）结果呈阳性。针对MPA进行了三次静脉注射环磷酰胺冲击治疗，随后病情缓解并采用硫唑嘌呤维持治疗。两年后，患者无症状，实验室指标正常。该病例突出表明MPA可累及颞动脉，并可伪装成颅部GCA。
