Digital Ulceration in a Patient with Interstitial Lung Disease: An Unusual Case of Microscopic Polyangiitis
DOI:
https://doi.org/10.37762/jgmds.11-3.592Keywords:
Microscopic Polyangiitis, Antineutrophil Cytoplasmic Antibodies, p-ANCA, ILDAbstract
OBJECTIVES
Microscopic polyangiitis (MPA) is part of the associated vasculitis family of the neutrophil cytoplasmic antibody (ANCA). MPA can be distinguished by its positivity for antibodies against myeloperoxidase (MPO-ANCA). The condition can involve any organ of the body, particularly the lungs, kidneys, and skin. This case highlights an atypical case of MPA in which a patient had interstitial lung disease (ILD) and later developed a vasculitic skin lesion without renal involvement. A 65-year-old female already diagnosed with ILD was evaluated for digital ulcers associated with bilateral pins and needle sensation in both upper and lower limbs. Examination revealed lesions on the index and middle finger of the left hand. The MPO-ANCA antibody test was positive, and a diagnosis of MPA was made based on a skin lesion biopsy. There was subsequent initiation of combination therapy consisting of azathioprine, hydroxychloroquine, prednisolone, and nifedipine. The patient was instructed for close follow-up. This case report highlights the importance of considering an underlying vasculitis in patients with ILD and emphasizes the significance of a thorough diagnostic evaluation and multidisciplinary management. This case also highlights that patients with interstitial lung diseases should be evaluated for secondary causes, and early treatment of the exact causes can prevent the late sequelae of the disease, such as skin manifestations in this patient.
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