title: A case of ANCA-associated vasculitis presenting with calf claudication.
abstract: Wegener's granulomatosis (WG), Churg-Strauss syndrome, and microscopic polyangiitis (MPA) are closely related small vessel vasculitides characterized by anti-neutrophil cytoplasmic antibodies (ANCA). Although there were some reports of MPA presenting with claudication, there are very few reports on WG presenting with claudication of calf muscles. We report an unusual case of ANCA-associated vasculitis in a 75-year-old man who presented with bilateral calf claudication. Comprehensive evaluations, including electromyography, nerve conduction study, lower extremity magnetic resonance imaging, and Doppler scan, did not reveal any other cause of bilateral calf claudication. P-ANCA and anti-myeloperoxidase antibody was positive, but the anti-proteinase 3 antibody was negative. Chest computed tomography scan showed subpleural honeycombing and reticulation, predominantly in both basal lung areas. Biopsy of the calf muscle showed granulomatous vasculitis. Kidney biopsy was also performed which revealed focal necrotizing glomerulonephritis. Our patient does not exhibit typical clinical features for WG, but histopathologic findings of necrotizing granulomatous vasculitis in calf muscle biopsy is highly suggestive of WG.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
authors.forename: Mi Yeon
authors.initials: MY
authors.lastname: Kim
authors.forename: Sun Youn
authors.initials: SY
authors.lastname: Bae
authors.forename: Mirae
authors.initials: M
authors.lastname: Lee
authors.forename: Hojung
authors.initials: H
authors.lastname: Chung
authors.forename: Jaejoon
authors.initials: J
authors.lastname: Lee
authors.forename: Joong Kyong
authors.initials: JK
authors.lastname: Ahn
authors.forename: Hoon-Suk
authors.initials: HS
authors.lastname: Cha
authors.forename: Eun-Mi
authors.initials: EM
authors.lastname: Koh
mesh_terms: D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D001379:Azathioprine / Q000627:therapeutic use; D004576:Electromyography; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000209:etiology*; D007866:Leg; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D001379:Azathioprine