[Severe necrotising primary vasculitis--case report].
BACKGROUND
Vasculitis is an inflammatory disorder of the vessels, often associates with necrosis. The primary (idiopathic) form caused by distinct immunological mechanisms, the secondary form caused by infection, tumor, drugs or systemic autoimmune disease.


METHODS
57-year-old smoking female patient with a medical history of the left ankle fracture. Four days earlier had sore throat, at admission was febrile and generally weak and had severe pain in her lower extremities. Physical examination revealed numerous livid alterations in both lower extremities, necrotic change of some toes and new onset of diastolic hypertension. Elevated serum transaminase levels, severe thrombopenia, anemia, leukocytosis suggested the possibility of thrombotic thrombocytopenic purpura and vasculitis. Tests ruled out septic embolism, therefore we applied high dose steroid treatment and plasma exchange. Meanwhile the results fulfilled the classification criteria of polyarteritis nodosa (vasculitis, livedo reticularis, polyneuropathia and new onset of diastolic hypertension), accordingly we synchronized the treatment with fractionally administered intravenous cyclophosphamide. The process revealed responsive to therapy and the substantive function of the legs remained after surgical removal of the necrotic areas.


CONCLUSIONS
Early rapid diagnosis of vasculitis is fundamental and we emphasize the significance of the efficient treatment.
Griger
Zoltán
Z
Debreceni Egyetem, Orvos- es Egészségtudományi Centrum, Belgyógyászati Intézet, III. Sz. Belgyógyászati Klinika, H-4032, Debrecen. grigerz@googlemail.com
Szántó
Antónia
A
Szabó
Nóra Anna
NA
Soltész
Pál
P
Zeher
Margit
M
D005260:Female; D005528:Foot / Q000473:pathology; D005534:Foot Diseases / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D010488:Polyarteritis Nodosa / Q000473:pathology*; D020293:Vasculitis, Central Nervous System / Q000473:pathology*