[Fulminant alveolar hemorrhage: evolution of giant cell arteritis to ANCA-positive vasculitis?].
BACKGROUND
Giant cell arteritis (GCA) is a granulomatous vasculitis of the large and medium size vessels with a remarkable sensitivity to corticosteroids, although it may be dependent to therapy. In rare cases, a vasculitis of the medium or small-size vessels may mimic, be associated to, or follow GCA. We report a case of GCA dependent to corticosteroids that was followed five years after diagnosis by an alveolar hemorrhage leading to the diagnosis of a possible Wegener's granulomatosis.


METHODS
A 70-year-old man had a diagnosis of GCA fulfilling the ACR criteria in 1999. Temporal artery biopsy revealed a typical histological pattern. The initial response to corticosteroids was excellent, but the patient became dependent to corticosteroids, so he was given methotrexate from 2002. Severe alveolar haemorrhage occurred in December 2004, leading to the diagnosis of possible ANCA positive, anti-proteinase 3 positive Wegener's granulomatosis.


CONCLUSIONS
ANCA-positive vasculitis may complicate the course of GCA. This evolution should be rapidly recognized, because its treatment differs to that of GCA.
Garrouste
C
C
Service de médecine interne, Pavillon Dieulafoy, hôpital Purpan, CHU de Toulouse, 1, place Docteur-Baylac, 31059 Toulouse Cedex, France.
Sailler
L
L
Astudillo
L
L
Lavayssière
L
L
Cointault
O
O
Borel
C
C
Bernard
J
J
Arlet
P
P
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic; D001706:Biopsy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D013700:Giant Cell Arteritis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D010951:Plasma Exchange; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011650:Pulmonary Alveoli; D013902:Radiography, Thoracic; D013699:Temporal Arteries / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone; D008775:Methylprednisolone