Abdelhalim Omar, Saha Utsow, Swaminathan Gowri, Bhutta Zara, Al-Howthi Nuha, Abosheaishaa Hazem
Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA.
Internal Medicine/Gastroenterology, Cairo University, Cairo, EGY.
Cureus. 2024 Dec 16;16(12):e75833. doi: 10.7759/cureus.75833. eCollection 2024 Dec.
Vasculitides represent a range of disorders marked by inflammation of blood vessels, often posing significant diagnostic challenges due to their diverse clinical presentations and involvement of multiple organ systems. We present the case of a 26-year-old woman who arrived with hemoptysis and a background of exertional dyspnea, chest pain, and occasional visual disturbances. Initial investigations showed elevated perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCAs) and myeloperoxidase antibodies (MPOs), indicative of microscopic polyangiitis (MPA). Imaging revealed circumferential thickening of the aorta and its branches, occlusion of the left subclavian and common carotid arteries, and ground-glass opacities in the lungs, suggesting the involvement of both large and small vessels. Although the findings suggested both MPA and Takayasu arteritis (TA), differentiating between these conditions was challenging due to overlapping clinical and radiological features. Treatment with prednisone and rituximab initially brought the symptoms under control, but the patient later experienced a relapse, illustrating the complexity of managing simultaneous small- and large-vessel vasculitis. This case highlights the necessity for a comprehensive diagnostic approach and personalized treatment strategies in handling complex vasculitides with multisystem involvement.
血管炎是一系列以血管炎症为特征的疾病，由于其临床表现多样且累及多个器官系统，常常带来重大的诊断挑战。我们报告了一例26岁女性病例，该患者因咯血前来就诊，伴有劳力性呼吸困难、胸痛和偶尔的视觉障碍病史。初步检查显示核周抗中性粒细胞胞浆抗体（P-ANCA）和髓过氧化物酶抗体（MPO）升高，提示显微镜下多血管炎（MPA）。影像学检查显示主动脉及其分支呈环形增厚，左锁骨下动脉和颈总动脉闭塞，肺部出现磨玻璃影，提示大小血管均受累。尽管检查结果提示同时存在MPA和大动脉炎（TA），但由于临床和放射学特征重叠，区分这两种疾病具有挑战性。最初使用泼尼松和利妥昔单抗治疗使症状得到控制，但患者后来复发，这说明了同时管理小血管和大血管血管炎的复杂性。该病例强调了在处理累及多系统的复杂血管炎时，采用综合诊断方法和个性化治疗策略的必要性。
