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Miyabe C, Miyabe Y, Miyata R, Ishiguro N. Pathogens in Vasculitis: Is It Really Idiopathic? JMA J 2021; 4:216-224. [PMID: 34414315 PMCID: PMC8355637 DOI: 10.31662/jmaj.2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 11/27/2022] Open
Abstract
Vasculitis is an autoimmune disease characterized by the infiltration of leukocytes in blood vessels. An increasing number of studies on human and animal models have implicated various microorganisms in the pathogenesis of vasculitis. Previous studies have shown the presence of infectious agents, including viruses, bacteria, and fungi, in diseased vessels. However, despite continued research, the link between infection and vasculitis is not fully understood, possibly owing to the lack of appropriate animal models that mirror human disease and the technical limitations of pathogen detection in blood vessels. Among the pathogen-induced animal models, Candida albicans water-soluble fraction (CAWS)-induced coronary arteritis is currently considered one of the representative models of Kawasaki (KD) disease. Advances in metagenomic next-generation sequencing have enabled the detection of all nucleic acids in tissue, which can help identify candidate pathogens, including previously unidentified viruses. In this review, we discuss the findings from reports on pathogen-associated vasculitis in animal models and humans, with a specific focus on the investigation of the pathogenesis of vasculitis. Further studies on animal models and microbes in diseased vessels may provide important insights into the pathogenesis of vasculitis, which is often considered an idiopathic disease.
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Affiliation(s)
- Chie Miyabe
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshishige Miyabe
- Department of Cell Biology, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
| | - Ryujin Miyata
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoko Ishiguro
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
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2
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Fraticelli P, Benfaremo D, Gabrielli A. Diagnosis and management of leukocytoclastic vasculitis. Intern Emerg Med 2021; 16:831-841. [PMID: 33713282 PMCID: PMC8195763 DOI: 10.1007/s11739-021-02688-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
Leukocytoclastic vasculitis (LCV) is a histopathologic description of a common form of small vessel vasculitis (SVV), that can be found in various types of vasculitis affecting the skin and internal organs. The leading clinical presentation of LCV is palpable purpura and the diagnosis relies on histopathological examination, in which the inflammatory infiltrate is composed of neutrophils with fibrinoid necrosis and disintegration of nuclei into fragments ("leukocytoclasia"). Several medications can cause LCV, as well as infections, or malignancy. Among systemic diseases, the most frequently associated with LCV are ANCA-associated vasculitides, connective tissue diseases, cryoglobulinemic vasculitis, IgA vasculitis (formerly known as Henoch-Schonlein purpura) and hypocomplementemic urticarial vasculitis (HUV). When LCV is suspected, an extensive workout is usually necessary to determine whether the process is skin-limited, or expression of a systemic vasculitis or disease. A comprehensive history and detailed physical examination must be performed; platelet count, renal function and urinalysis, serological tests for hepatitis B and C viruses, autoantibodies (anti-nuclear antibodies and anti-neutrophil cytoplasmic antibodies), complement fractions and IgA staining in biopsy specimens are part of the usual workout of LCV. The treatment is mainly focused on symptom management, based on rest (avoiding standing or walking), low dose corticosteroids, colchicine or different unproven therapies, if skin-limited. When a medication is the cause, the prognosis is favorable and the discontinuation of the culprit drug is usually resolutive. Conversely, when a systemic vasculitis is the cause of LCV, higher doses of corticosteroids or immunosuppressive agents are required, according to the severity of organ involvement and the underlying associated disease.
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Affiliation(s)
- Paolo Fraticelli
- Dipartimento Di Scienze Cliniche E Molecolari, Clinica Medica, Università Politecnica Delle Marche, Via Tronto 10/A, 60127, Ancona, Italy.
| | - Devis Benfaremo
- Dipartimento Di Scienze Cliniche E Molecolari, Clinica Medica, Università Politecnica Delle Marche, Via Tronto 10/A, 60127, Ancona, Italy
| | - Armando Gabrielli
- Dipartimento Di Scienze Cliniche E Molecolari, Clinica Medica, Università Politecnica Delle Marche, Via Tronto 10/A, 60127, Ancona, Italy
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3
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Yamauchi N, Tanda S, Kashiwagi S, Ohnishi A, Kugai M, Akazawa T, Matsumoto T, Yamauchi J, Muramatsu A, Fujimoto S. Fatal gastrointestinal bleeding due to IgA vasculitis complicated with tuberculous lymphadenitis: A case report and literature review. Clin Case Rep 2020; 8:1741-1747. [PMID: 32983488 PMCID: PMC7495800 DOI: 10.1002/ccr3.2938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 01/24/2023] Open
Abstract
We report a case of IgA vasculitis that developed during the treatment of tuberculosis. Patients with tuberculosis who are on antituberculosis treatment can be administered steroids for severe disease or complications.
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Affiliation(s)
| | - Shuji Tanda
- Department of NephrologyAkashi City HospitalAkashiJapan
| | - Saori Kashiwagi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Munehiro Kugai
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Takako Akazawa
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | | | - Junko Yamauchi
- Department of GastroenterologyAkashi City HospitalAkashiJapan
| | - Akira Muramatsu
- Department of GastroenterologyAkashi City HospitalAkashiJapan
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4
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Wang JY, Brown RA, Pugliese S, Kwong BY, Novoa RA. Disseminated tuberculosis presenting as medium-vessel vasculitis in an immunocompromised host. J Cutan Pathol 2020; 47:725-728. [PMID: 32133689 DOI: 10.1111/cup.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022]
Abstract
Cutaneous tuberculosis is an uncommon entity with several clinical forms recognized. Histopathologically, most cases are characterized by granulomatous inflammation and caseating necrosis, although less common findings, including vasculitis, have also been described. We report a 55-year-old male with a history of recently diagnosed dermatomyositis receiving immunosuppression with mycophenolate mofetil and prednisone, who developed multifocal soft tissue abscesses and an indurated erythematous plaque on the back. Skin biopsy of the back revealed a necrotizing medium-vessel vasculitis. Mycobacterium tuberculosis was detected in the skin via acid-fast bacilli stain and confirmed by tissue culture and polymerase chain reaction. Cutaneous findings improved rapidly with antituberculosis therapy. This case illustrates an uncommon clinical and histopathologic presentation of disseminated tuberculosis.
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Affiliation(s)
- Jennifer Y Wang
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Ryanne A Brown
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Silvina Pugliese
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
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5
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Chhabria BA, Nampoothiri RV, Rajpal S, Gupta K, Jain S. Rare Association of Leukocytoclastic Vasculitis in Visceral Leishmaniaisis. Oman Med J 2019; 34:66-69. [PMID: 30671187 PMCID: PMC6330183 DOI: 10.5001/omj.2019.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 30-year-old man presented with fever, hepatosplenomegaly, and a rash over his lower limbs (palpable purpura). Evaluation revealed pancytopenia and hypergammaglobulinemia. A subsequent bone marrow examination and serology confirmed visceral leishmaniasis (kala-azar), while the biopsy of skin lesion suggested leukocytoclastic vasculitis. No alternate cause of vasculitis was forthcoming, and the patient was treated with conventional amphotericin B for 14 days after which resolution of symptoms (including the rash) was noted. Cutaneous vasculitis is an extremely rare complication following visceral leishmaniasis with no known cases reported thus far. Hence, a high index of suspicion is warranted in achieving timely diagnosis and initiation of appropriate therapy.
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Affiliation(s)
- Bharath A Chhabria
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram V Nampoothiri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sweta Rajpal
- Department of Hematopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Rafiei N, Khanlou N, Khosa S, Moheb N, Mishra SK. A Case of Tuberculosis-related Leukocytoclastic Vasculitis Presenting With Peripheral Neuropathy. Cureus 2018; 10:e3703. [PMID: 30788192 PMCID: PMC6372249 DOI: 10.7759/cureus.3703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberculous granulomatous vasculitis is commonly associated with meningitis and retinitis. We describe a 39-year-old male, with a history of pulmonary tuberculosis (TB) who presented with progressive weakness, pain, tingling and numbness in the bilateral lower extremities. Significant atrophy and weakness of the lower extremities were evident along with absent reflexes. Nerve conduction studies and electromyography showed severe axonal polyneuropathy and denervation on the lower extremities. Nerve biopsy demonstrated small vessel leukocytoclastic vasculitis without any granuloma formation. Muscle biopsy was consistent with denervation and atrophy with target fiber changes. Tuberculosis-related vasculitis causing peripheral neuropathy is extremely rare and our case is unique in manifesting this presentation.
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Affiliation(s)
- Nastaran Rafiei
- Neurology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Negar Khanlou
- Pathology, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Shaweta Khosa
- Neurology, Olive View - University of California Los Angeles Medical Center, Los Angeles, USA
| | - Negar Moheb
- Neurology, Olive View - University of California Los Angeles Medical Center, Los Angeles, USA
| | - Shri K Mishra
- Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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7
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Fabian E, Schneeweiss B, Valentin T, Flick H, Aigelsreiter A, Hofmann-Wellenhof R, Cerroni L, Goritschan AM, Brezinsek HP, Zitta S, Rosenkranz A, Graninger W, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 162: A 30-year-old woman from Nigeria with fever 3 months postpartum. Wien Klin Wochenschr 2017; 129:145-152. [PMID: 28120106 PMCID: PMC5318465 DOI: 10.1007/s00508-016-1164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Department of Internal Medicine, Hospital Kirchdorf on the Krems, Kirchdorf on the Krems, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Lorenzo Cerroni
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Anna Maria Goritschan
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hans-Peter Brezinsek
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Zitta
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Winfried Graninger
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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8
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Masiero A, Sztajnbok F, Rodrigues M, Fonseca A, Oliveira S, Goldenzon A, Vitor J, Silva P, Gasparello R, Diniz C. TUBERCULOSE CUTÂNEA MIMETIZANDO VASCULITE SISTÊMICA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Mosher CA, Owen JL, Barker BR. Staphylococcus aureus Bacteremia Masquerading as Leukocytoclastic Vasculitis. Am J Med 2016; 129:e5-7. [PMID: 26656759 DOI: 10.1016/j.amjmed.2015.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Christina A Mosher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
| | - Joshua L Owen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Blake R Barker
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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10
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Abstract
Small vessel vasculitis in the skin manifests with palpable purpura on the lower extremities. This clinical presentation prompts a complete physical examination, history, and review of systems, as well as biopsies for routine processing and direct immunofluorescence to confirm the diagnosis. The presence of vasculitis in other organs, associated underlying conditions, and the severity of cutaneous manifestations dictate management. The majority of cases are self-limited, and overall the prognosis is favorable. Still, a subset of patients can have serious complications and chronic or recurrent disease.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Victoria P Werth
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Departments of Dermatology and Medicine, Philadelphia Veterans Affairs Medical Center, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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11
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Bhatia V, Sibal A, Rajgarhia S. Antituberculosis therapy-associated cutaneous leukocytoclastic vasculitis. J Trop Pediatr 2013; 59:507-8. [PMID: 23780994 DOI: 10.1093/tropej/fmt048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Antituberculosis therapy-associated cutaneous leukocytoclastic vasculitis (CLV) has been rarely reported. We describe a case of CLV induced by rifampicin and pyrazinamide. A 14-year-old male diagnosed with disseminated tuberculosis developed purpuric lesions after 1.5 months of treatment. Histopathology was consistent with leukocytoclastic vasculitis. Skin lesion improved after cessation of the two drugs and treatment with corticosteroids.
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Affiliation(s)
- Vidyut Bhatia
- Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi 110076, India
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12
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Meziane M, Amraoui N, Taoufik H, Mernissi FZ. Cutaneous leukocytoclastic vasculitis revealing multifocal tuberculosis. Int J Mycobacteriol 2013; 2:230-2. [PMID: 26786128 DOI: 10.1016/j.ijmyco.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 07/29/2013] [Indexed: 11/28/2022] Open
Abstract
Cutaneous leukocytoclastic vasculitis (CLV) is an inflammatory vascular disorder rarely reported to be associated with tuberculosis. The following report describes the case of a young man with multifocal tuberculosis revealed by CLV. Diagnosis was confirmed by the presence of tuberculoid granuloma with caseous necrosis on pleural and perianal biopsy, and a rapid improvement in anti-tuberculous quadritherapy. Although rarely seen, Mycobacterium tuberculosis should be considered as a potential cause of CLV.
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Affiliation(s)
- Mariame Meziane
- Dermatological Department, Hassan II University Hospital, Fes, Morocco.
| | - Nisrine Amraoui
- Dermatological Department, Hassan II University Hospital, Fes, Morocco
| | - Harmouch Taoufik
- Laboratory of Pathology, Hassan II University Hospital, Fes, Morocco
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13
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Bueno Filho R, Cordeiro AP, Almeida FTD, Shaletich C, Costa RS, Roselino AMF. Rare association of cutaneous vasculitis, IgA nephropathy and antiphospholipid antibody syndrome with tuberculous lymphadenitis. Clinics (Sao Paulo) 2012; 67:1497-500. [PMID: 23295608 PMCID: PMC3521817 DOI: 10.6061/clinics/2012(12)24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Roberto Bueno Filho
- University of São Paulo, School of Medicine of Ribeirão Preto, Department of Medical Clinics, Division of Dermatology, Ribeirão Preto/SP, Brazil
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14
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Yao Y, Liu B, Wang JB, Li H, Liang HD. Tuberculosis should not be ignored in patients with peripheral gangrene. J Vasc Surg 2010; 52:1662-4. [PMID: 20843626 DOI: 10.1016/j.jvs.2010.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/04/2010] [Accepted: 07/09/2010] [Indexed: 11/25/2022]
Abstract
Peripheral gangrene, characterized by distal ischemia of the extremities, is a rare complication in patients with tuberculosis (TB). We diagnosed a female patient with gangrene of her left toe caused by TB infection. She presented with fever, lymphadenectasis, and peripheral gangrene of the left toe. Lymph node biopsy confirmed tuberculous lymphadenitis and the computer tomography angiography showed vasculitis. The patient underwent antituberculous therapy and her condition was gradually improved. Although it is rare, TB should be considered as a possible cause of peripheral gangrene.
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Affiliation(s)
- Yuan Yao
- Department of Rheumatology, The Affiliation Hospital of QingDao University Medical College, No.16 Jiang Su Lu, Shi Nan District, QingDao City, Shandong Province, China
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15
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Current World Literature. Curr Opin Rheumatol 2008; 20:111-20. [DOI: 10.1097/bor.0b013e3282f408ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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