title: [Severe necrotising primary vasculitis--case report].
abstract: 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.
authors.affiliation: Debreceni Egyetem, Orvos- es Egészségtudományi Centrum, Belgyógyászati Intézet, III. Sz. Belgyógyászati Klinika, H-4032, Debrecen. grigerz@googlemail.com
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Griger
authors.forename: Antónia
authors.initials: A
authors.lastname: Szántó
authors.forename: Nóra Anna
authors.initials: NA
authors.lastname: Szabó
authors.forename: Pál
authors.initials: P
authors.lastname: Soltész
authors.forename: Margit
authors.initials: M
authors.lastname: Zeher
mesh_terms: 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*