A Case of Microscopic Polyangiitis Presenting as Cranial Giant Cell Arteritis

Evangelatos, Gerasimos; Fragoulis, G.; Iliopoulos, Alexios

doi:10.31138/mjr.31.4.412

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…Sirs, Renal involvement, showing a pauci-immune focal crescentic glomerulonephritis, is typical of microscopic polyangiitis (MPA) but absent in giant cell arteritis (GCA). MPA patients may show inflammation in the temporal artery (1). However, they have typical necrotising vasculitis findings such as the presence of fibrinoid necrosis with polymorphonuclear leukocyte infiltration without giant cells.…”

Section: Letters To the Editors Biopsy-proven Giant Cell Arteritis In...mentioning

confidence: 99%

Biopsy-proven giant cell arteritis in an elderly woman diagnosed 11 years earlier with microscopic polyangiitis: two different vasculitis in the same patient separated in time

Fernandez-Prado,

García-Fernández,

Avello

et al. 2023

Clinical and Experimental Rheumatology

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Section: Letters To the Editors Biopsy-proven Giant Cell Arteritis In...mentioning

confidence: 99%

Biopsy-proven giant cell arteritis in an elderly woman diagnosed 11 years earlier with microscopic polyangiitis: two different vasculitis in the same patient separated in time

Fernandez-Prado,

García-Fernández,

Avello

et al. 2023

Clinical and Experimental Rheumatology

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Cranial giant cell arteritis mimickers: A masquerade to unveil

Evangelatos

Grivas

Παππά

et al. 2022

Autoimmunity Reviews

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Giant cell arteritis with myeloperoxidase anti-neutrophil cytoplasmic antibody seropositivity in a patient with systemic sclerosis

Kitahara

Nakamura

Kawai

et al. 2023

Modern Rheumatology Case Reports

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To the best of our knowledge, systemic sclerosis with overlapping characteristics of both microscopic polyangiitis and giant cell arteritis (i.e., microscopic polyangiitis involving the superficial temporal artery or giant cell arteritis with myeloperoxidase-anti-neutrophil cytoplasmic antibody seropositivity) has not been reported previously. An 82-year-old woman with diffuse cutaneous systemic sclerosis experienced dyspnea on exertion and fever. No signs of infection were observed on computed tomography. Her fever persisted despite antibiotic treatment for occult bacterial infection and secondary Clostridioides difficile-associated diarrhea. Microscopic polyangiitis was suspected because of myeloperoxidase-anti-neutrophil cytoplasmic antibody seropositivity, and giant cell arteritis was suspected as a differential diagnosis due to swelling of the superficial temporal artery. Arterial biopsy revealed inflammatory cell infiltration with granuloma formation. Based on the presence of granulomatous inflammation in the superficial temporal artery, we concluded that giant cell arteritis with myeloperoxidase-anti-neutrophil cytoplasmic antibody seropositivity occurred as a complication. After glucocorticoid therapy, her fever and dyspnea on exertion improved with a gradual decline in the serum myeloperoxidase-anti-neutrophil cytoplasmic antibody levels. It is possible that vasculitis occurs as a complication in patients with systemic sclerosis in cases where the fever persists and cannot be explained by systemic sclerosis itself, infectious disease, or malignancy. Clinicians must be careful not to prematurely diagnose microscopic polyangiitis based on myeloperoxidase-anti-neutrophil cytoplasmic antibody seropositivity or giant cell arteritis based on the swelling of the superficial temporal artery. Careful evaluation of the presence of granulomatous inflammation in an arterial biopsy specimen is essential to differentiate between microscopic polyangiitis and giant cell arteritis.

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A Case of Microscopic Polyangiitis Presenting as Cranial Giant Cell Arteritis

Cited by 3 publications

References 17 publications

Biopsy-proven giant cell arteritis in an elderly woman diagnosed 11 years earlier with microscopic polyangiitis: two different vasculitis in the same patient separated in time

Biopsy-proven giant cell arteritis in an elderly woman diagnosed 11 years earlier with microscopic polyangiitis: two different vasculitis in the same patient separated in time

Cranial giant cell arteritis mimickers: A masquerade to unveil

Giant cell arteritis with myeloperoxidase anti-neutrophil cytoplasmic antibody seropositivity in a patient with systemic sclerosis

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