Diffuse alveolar hemorrhage as an initial presentation of ANCA‑associated vasculitis in an 80‑year‑old man

Masiak, Anna; Buda, Natalia; Wojteczek, Anna; Kujawska-Danecka, Hanna; Zdrojewski, Zbigniew

doi:10.20452/pamw.4038

Cited by 2 publications

(2 citation statements)

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“…Reports concerning LUS applicability for the assessment of pulmonary changes secondary to connective tissue disease focus primarily on fibrosis in interstitial lung disease (ILD). Single publications indicate its applicability also in diagnostics of other, less common complications secondary to systemic connective tissue disease, e.g., DAH [16–17].…”

Section: Introductionmentioning

confidence: 99%

Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement

2019

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IntroductionGranulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are forms of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). AAV most commonly affects the upper and lower respiratory tract as well as the kidneys. The first symptoms are often nonspecific, requiring careful differential diagnosis with infections and malignancies.Materials and methodsWe analyzed the clinical and radiological data of 38 patients (20 females and 18 males) diagnosed with ANCA-associated vasculitis. Lung involvement was observed in 29 cases. Lung ultrasound (LUS) was performed on 21 patients from the study group and compared to chest CT. For 7 patients the examination was conducted repeatedly.ResultsIn total, 35 LUS and CT examinations were performed, revealing the following lesions: nodules, infiltrates with and without features of disintegration, caves (n = 17), diffuse alveolar hemorrhage (n = 3), and features of interstitial lung disease (ILD) with pulmonary fibrosis (PF) (n = 11). In 2 cases LUS and CT were negative. In 4 cases LUS was negative, despite a positive CT result.ConclusionsBoth in CT and LUS, images of pulmonary lesions were consistent though highly variable. Therefore, further studies are required for a larger group of patients.

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Section: Introductionmentioning

confidence: 99%

Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement

2019

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“…The efficacy of lung ultrasound (LUS) is very well documented in many pulmonary diseases (3,4). Single publications indicate its applicability also in diagnostics of complications secondary to systemic connective tissue disease, e.g., lung fibrosis or diffuse alveolar hemorrhage (5,6). The necessity of repeating chest imaging examinations increases the patient's exposure to ionizing radiation.…”

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Ab0601 utilization of a Multispecialty Team for the Diagnosis of Giant Cell Arteritis Reduces Patient Morbidity

Hassantoufighi

Lu-Do

Dhillon

et al. 2019

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Background:Giant Cell arteritis (GCA) is an autoimmune vasculitis, most commonly seen in older adults with a peak incidence in the seventh decade of life. A diagnosis of GCA is often considered in any patient over the age of 50 years who complains of or is found to have new onset headache, acute visual disturbances, jaw claudication, unexplained fever, or elevated inflammatory markers. Because the manifestations of GCA can vary considerably from patient to patient, often with transient and fluctuating symptoms, an accurate diagnosis can be challenging. Even in the setting of a negative temporal artery biopsy, many patients are treated empirically based on the perceived probability of disease. This approach can lead to significant morbidity from prolonged medication exposure and unnecessary procedures.Objectives:The aim for this project was to look at the impact of a collaborative effort amongst three specialties, rheumatology neurology and ophthalmology, which composed a consultation based “GCA team”, the goal of which was to improve how GCA is diagnosed and subsequently managed.Methods:We conducted a retrospective study of all patients suspected to have GCA at our institution over the last 2.5 years that had either been seen by the GCA team or not. The GCA team met either in person or had a conference call to discuss each case and make a joint decision regarding the diagnosis and treatment. Data extracted included patient demographics, symptoms on presentation, labs, biopsy results and accumulative prednisone dose.Results:A total of 30 patients (19 female, 11 male) were evaluated; 19 were seen by the GCA team and 11 were not. The mean ages of the patients in each group were the similar (GCA Team 70.6 (SD 12.5) vs no GCA Team 70.3 (SD 12.3)). The mean ESR between the two groups was also similar (GCA Team 53.3 (SD 30.2) vs no GCA Team 53.8 (SD 27.2)). The presenting clinical symptoms between the two groups were also comparable: visual complaints (63% vs 73%), headache/jaw claudication/temporal artery tenderness (42% vs 45%), and cranial neuropathy (11% vs 9%).All of the patients not seen by the GCA team underwent bilateral temporal artery biopsy; however none were positive on histology. Regardless, all were continued on high dose prednisone with a 6 month cumulative mean dose of 5,350mg.Of the 19 patients seen by the GCA team, 8 were determined to be low probability for GCA and thus were spared temporal artery biopsy. Furthermore, all of the patients were recommended a rapid steroid taper and the cumulative mean dose of prednisone was only 490mg. Over 6 months of follow-up, none of the 8 patients deemed low probability had a subsequent diagnosis of GCA given.Compared to patients deemed high probability by the GCA team, low probability patients were younger (68.6 vs 71.2), more often female (75% vs 45%), had lower ESR (40.5 mm/hr vs 66.1 mm/hr), and presented with more visual complaints (86% vs 46%).In the 11 high probability GCA patients, 10 underwent temporal artery biopsy (one refused) with 4 biopsies read as pos...

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Diffuse alveolar hemorrhage as an initial presentation of ANCA‑associated vasculitis in an 80‑year‑old man

Cited by 2 publications

References 3 publications

Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement

Utility of lung ultrasound in ANCA-associated vasculitis with lung involvement

Ab0601 utilization of a Multispecialty Team for the Diagnosis of Giant Cell Arteritis Reduces Patient Morbidity

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