Discussion: DKA is a serious complication of diabetes mellitus, and its metabolic derangements can have various deleterious effects on numerous organ systems. Myopericarditis is an extension of pericardial inflammation to the myocardium, evidenced by elevated biomarkers and/or EKG changes, without left ventricular dysfunction. Since 1971, only a handful of cases have described DKA leading to acute pericarditis, demonstrating a potential complication of DKA that could be frequently overlooked.
chest pain. The resident at bedside noticed visibly significant ST-elevations on bedside telemetry, which was confirmed by a emergent electrocardiogram. The echocardiogram was negative for any wall motion abnormalities or effusions. The initial troponin that evening was 0.014 ng/mLwhich peaked at 13.8 ng/mL by the next morning. She was promptly taken for a coronary angiogram, which was negative for coronary artery disease or spontaneous coronary artery dissection. By day four, the patient was downgraded to hospital medicine and discharged by day six.
A RARE AND UNUSUAL CASE OF RHEUMATOID VASCULITIS AFTER SHORT TERM CESSATION OF MAINTENANCE MEDICATIONS. Michelle Livitz, Mary Katherine Moore, Keyur Patel, Jessica Blanchard, Seth Vignes; Louisiana State University, New Orleans.
Introduction: Rheumatoid vasculitis (RV) is a rare complication of long-standing rheumatoid arthritis (RA) with a high associated morbidity and mortality. It is characterized by necrotizing or leukocytoclastic vasculitis of small/medium-sized vessels. The most common organ systems involved are the skin and peripheral nerves but can be life- threatening with major organ involvement.
CCP antibodies and rheumatoid factor. She was also found to have type III cryoglobulinemia showing mixed polyclonal immunoglobulins in the setting of a negative hepatitis C RNA viral load. Per rheumatology recommendations, she was started back on a higher prednisone dose with a taper to her maintenance dose, restarted Methotrexate, and arranged for outpatient follow up. Discussion: RV is a rare presentation, and typically seen in people with long-standing untreated RA. It is incredibly uncommon that after 4 months without treatment that the patient developed such a severe complication. Peripheral neuropathy and/or purpura/petechiae are the most important clinical features to discriminate patients with RA with and without histologically proven RV. Only the combination of an increased serum IgA rheumatoid factor level and a decreased serum complement 3 level appeared to make an additional contribution to the diagnosis histologically proven RV. A biopsy of a large muscle group, such as rectus femoris, would be confirmational of this diagnosis. Ultimately treatment for this condition is high dose corticosteroids and immunosuppressive therapy, like Methotrexate. Biologic therapies are currently widely debated without consensus.
Case: A 78-year-old female with seropositive RA, chronic obstructive pulmonary disease,
hypothyroidism, and polymyositis presented for a new rash that began on her bilateral hands, thighs, and back with associated distal extremity paresthesias and subjective fever and chills. The patient reported seeing her rheumatologist four months prior to presentation and due to a miscommunication, she stopped taking her maintenance methotrexate and prednisone. After several months without treatment, she had a recurrence of her right knee pain, a similar presentation to her prior flares. Upon admission, labs were drawn given concern for a repeat RA flare. A urinalysis showed proteinuria. Labs showed elevated erythrocyte sedimentation rate and C-reactive protein, normal complement 3, undetectably low complement 4, negative antinuclear antibody, RNP antibody, anti-smith antibodies, and high
19
Made with FlippingBook Digital Publishing Software