Rheumatoid Arthritis Presenting with Raynaud’s Phenomenon in an Elderly: End of Road?

Rheumatoid Arthritis (RA) is an autoimmune and chronic inflammatory disorder where the immune system of the body attacks the healthy cells and causes inflammation. Raynaud’s Phenomenon (RP) is a disorder of small blood vessels supplying the distal parts of the limbs where decrease in blood supply leads to infarction of that area. It occurs secondary to other disorders as in this case with RA. The report is about an 80-year-old female patient who presented with chief complaints of bluish discolouration over distal parts of hands and feet as well as pain in joints of all limbs. She had gangrene developing over the tips of fingers and toes, ulcer over the lower end of right foot, cold extremities, swelling over elbow and knee joints, oedematous hands and feet, and loss of pin prick needle sensations. With all the clinical presentations and investigation findings, the patient was diagnosed with RA presenting with RP. The patient was first started with the treatment for RA and then was managed symptomatically for vasculitis. Due to the old age factor and the advanced stage of the disease, the patient developed septicaemia and died due to cardiac arrest

Takayasu's disease presenting with tubercular empyema: A rare presentation of a rare disease

Takayasu's disease (TD) also known as pulseless disease is an arteriopathy characterized by vasculitis affecting the aorta and its branches. It is also known as aortic arch syndrome, nonspecific aorto-arteritis, and young female arteritis. Pulmonary artery involvement in Takayasu's arteritis is a rare phenomenon. Pulmonary artery vasculitis leads to pulmonary arterial hypertension and rarely manifests as pleural effusion. Patients with pulmonary arteritis and pleural effusion usually present as chest pain, cough, and dyspnea. Percentage of involvement of pulmonary artery in TD is variable. Pleural effusion occurs as sequelae of pulmonary artery involvement. We report the case of a 46-year-old female who presented to us with fever, weight loss, dyspnea, and chest pain. Clinical examination and investigations revealed Takayasu's arteritis and tubercular empyema. This case report is a rare presentation of Takayasu's arteritis with tubercular empyema without pulmonary arteritis