Vasculitis de presentación atípica

Abstract

This titling work aims to describe a clinical case of small vessel vasculitis type Wegener's granulomatosis with an atypical clinic and confirmed by paraclinical in the José Maria Velasco Ibarra Hospital in Tena city. We describe the case of a 63-year-old female patient with no significant medical history who came to the emergency department due to: edema in the lower limbs, predominantly in the lower right limb due to a possible infectious cause. After her admission, she developed palpable purpuric spots at the level of lower and upper legs. Complementary studies were performed, reporting: creatinine 2.74 mg/dl, antinuclear antibodies 13.5 positive, anti-neutrophil cytoplasmic antibodies perinuclear 1,6 negative and cytoplasmic 16.4 positive. High C3 complement, normal C4 complement, positive rheumatoid factor, persistent elevation of the polymerase chain reaction and erythrocyte rate. A computed tomography of the thorax reports interstitial pneumonia to rule out causes of autoimmune origin, skin biopsy reports nonspecific chronic dermatitis compatible with vasculitis. Immunosuppressive treatment is initiated with boluses of methylprednisolone to avoid progressive deterioration of renal function producing improvement of their clinical condition. The nonspecific clinical manifestations presented in the form of palpable purpura, edema of the lower limbs and absence of symptoms at the level of the upper respiratory tract, make it necessary to confirm the diagnosis and type of vasculitis through histopathological studies and anti-cytoplasmic antibodies neutrophils, respectively. High-dose corticosteroids remain the fundamental pillar for the remission of the disease with renal involvement.