Acute Onset Rheumatoid Vasculitis With Polyarthritis and Erythema: A Case Report

Rheumatoid Vasculitis Involving Gastrointestinal Tract Pre-dating Rheumatoid Arthritis: A Case Study and Literature Review

Rheumatoid vasculitis (RV) constitutes a rare but serious complication of rheumatoid arthritis (RA), characterized by the inflammation of small and medium-sized blood vessels. We present a case of a 34-year-old male with chronic alcoholism who presented with epigastric pain, hematemesis, purpuric rashes, and multiple joint swelling and pain, without prior RA diagnosis. Abdominal angiography was unremarkable, ruling out Polyarteritis Nodosa (PAN) and Mallory Weiss tear. Upper GI endoscopy revealed erosive gastroduodenitis, and biopsies confirmed small vessel leukocytoclastic vasculitis with fibrinoid necrosis, initially raising suspicion of Henoch-Schonlein Purpura (HSP). However, positive rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, elevated inflammatory markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)), and negative immunoassay tests led to the diagnosis of RV. Treatment with intravenous hydrocortisone led to rapid improvement, and the patient is now being monitored on an outpatient basis with progressive recovery. This case underscores the unusual presentation of gastrointestinal involvement in RV. It highlights the importance of considering RV as a primary diagnosis, even in the absence of a prior RA diagnosis. Early recognition and intervention are critical for managing complications, emphasizing the need for a high index of suspicion in rheumatic diseases' unusual presentations.

Eosinophilic Granulomatosis With Polyangiitis Gradually Worsening With Consecutive Pregnancies: A Case Report

This case report elucidates the diagnosis and management of eosinophilic granulomatosis with polyangiitis (EGPA), a form of systemic vasculitis, in a 32-year-old female presenting with progressive dermal, respiratory, and gastrointestinal symptoms following multiple pregnancies. The patient's history of allergic reactions and pregnancies suggested a gradual progression of EGPA, a condition rarely associated with pregnancy. Initial symptoms were misinterpreted as allergic reactions and acute gastroenteritis, delaying the correct diagnosis. Laboratory findings included eosinophilia and elevated immunoglobulin E, while further investigations ruled out other differential diagnoses, such as chronic eosinophilic leukemia. A clinical diagnosis of EGPA was made based on symptom progression, eosinophilia, and mononeuritis multiplex, absent typical granulomatous changes in the skin biopsy. Treatment with high-dose prednisolone and rituximab halted disease progression and improved symptoms, highlighting the critical importance of prompt diagnosis and treatment in preventing irreversible complications. This case emphasizes the need for general physicians to consider pregnancy as a potential trigger for autoimmune diseases like EGPA, especially in patients presenting with multi-symptom allergic reactions and high inflammatory markers.

Atlantoaxial Subluxation as the Initial Presentation of Rheumatoid Arthritis: A Case Report

Rheumatoid arthritis (RA) is known for its diverse manifestations, although atlantoaxial subluxation is a rare complication. This case report sheds light on the complexity of RA diagnosis, especially in the elderly, and emphasizes the significance of primary care in identifying atypical presentations. A 68-year-old male with a history of chronic obstructive pulmonary disease, hypertension, prior traumatic neck spinal injury, and lumbosacral stenosis presented to a rural community hospital with neck pain, bilateral numbness, and arm weakness. Initially diagnosed with degenerative cervical spondylosis, his condition later progressed to include swollen, painful wrists and metacarpophalangeal joints. Diagnostic tests revealed elevated rheumatoid factor and C-reactive protein, and hand X-ray showed bone erosions. An MRI confirmed an atlantoaxial subluxation. He was diagnosed with RA based on the American College of Rheumatology/European League Against Rheumatism 2010 criteria with a score of 7. The patient underwent cervical fusion surgery and rehabilitation, leading to significant functional improvement. This case underscores the importance of a comprehensive diagnostic approach in primary care for elderly patients presenting with non-specific symptoms. It highlights the need for heightened awareness among general practitioners of atypical RA manifestations, such as atlantoaxial subluxation. The case advocates for continued research into early detection and management strategies for such rare presentations to enhance patient outcomes in RA.

Diagnosis of Rheumatoid Vasculitis From Ischemic Change in Hands: A Case Report

Rheumatoid arthritis (RA) is a chronic inflammatory disorder with a wide clinical heterogeneity. Among its complications, rheumatoid vasculitis (RV) is notable for its severity and potential to involve multiple organ systems. A particularly serious manifestation of RV is ischemia, which is indicative of advanced vasculitic involvement and a significant risk of tissue damage. This case report describes an 83-year-old male with RA who presented with polyarticular joint pain and hand ischemia. Despite the initial diagnosis of RA exacerbation, worsening systemic symptoms without identifiable infectious causes and hypocomplementemia led to the diagnosis of RV exacerbation. Initial management with steroids showed temporary improvement. However, relapse after dose reduction prompted the administration of rituximab, an anti-cluster-of-differentiate-20 (anti-CD20) monoclonal antibody, which yielded favorable outcomes. This case underscores the importance of clinical vigilance in older patients with RA for signs, such as ischemic hands, emphasizing the pivotal role of early detection and intervention in RV management, particularly in community hospital settings.