Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.
BMJ Case Rep. 2022 Jun 10;15(6):e249487. doi: 10.1136/bcr-2022-249487.
A man in his late 50s presented with unilateral pain and discolouration of his fourth and fifth toes suggestive of digital ischaemia. He had a medical history of two unprovoked venous thromboembolisms in the preceding 18 months and a history of monoclonal gammopathy of undetermined significance (MGUS). A CT scan showed evidence of large vessels vasculitis in the absence of circulating antineutrophil cytoplasmic antibodies. Biopsy of the toes showed evidence of light chain and immunoglobulin deposition on immunofluorescence suggesting vasculitis secondary to his haematological diagnosis of MGUS. The patient was treated with high dose glucocorticoids and immunosuppressive treatment with a significant improvement in his symptoms and features of digital ischaemia.
一位 50 多岁的男性出现单侧疼痛和第四、五脚趾变色，提示有手指缺血。他在过去 18 个月内有两次无诱因的静脉血栓栓塞病史，并有意义未明的单克隆丙种球蛋白血症（MGUS）病史。CT 扫描显示大血管血管炎的证据，而无循环中性粒细胞胞质抗体。脚趾活检显示免疫荧光检查有轻链和免疫球蛋白沉积，提示继发于他的血液学诊断的 MGUS 的血管炎。该患者接受了大剂量糖皮质激素和免疫抑制治疗，症状和手指缺血的特征明显改善。
