A Rare Presentation of Polyarteritis Nodosa

Polyarteritis nodosa (PAN) is a rare form of necrotizing medium-vessel vasculitis. PAN has the potential for widespread organ involvement, but the skin, renal, neurologic, and musculoskeletal systems are most commonly involved. A definitive diagnosis can be made with a biopsy of an easily accessible organ such as the skin or an involved nerve or muscle. We present a case of a 66-year-old female with no significant past medical history who presented with chest and epigastric pain. She was subsequently found to have computed tomography angiography (CTA) findings consistent with PAN, including areas of arterial narrowing alternating with areas of aneurysmal dilation confined to the mesenteric arteries. A biopsy of the involved arteries was deemed unsafe and ultimately not performed. Her lab findings were remarkable for elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and unremarkable for a broad infectious disease workup. Suspicion of PAN was further strengthened by a positive response to, and eventual full recovery on, high-dose steroids alone

A Case of T-Cell Large Granulocyte Lymphocytic Leukemia in Rheumatoid Arthritis

T-cell large granulocyte lymphocytic (TLGL) leukemia is a lymphoproliferative disorder involving clonal expansion of cytotoxic T-cells and subsequent cytopenia, most notably neutropenia, as well as splenomegaly. TLGL leukemia is commonly associated with autoimmune disorders, most commonly rheumatoid arthritis (RA). We present a case of a 54-year-old female with a past medical history of seropositive RA who was lost to follow-up and thus was not on any active treatment for RA for several years. She returned to the clinic with worsening joint pain, swelling, and stiffness involving multiple joints. Screen laboratory work revealed an absolute neutrophil count (ANC) of 0.19 K/uL, indicating severe neutropenia. This finding prompted further workup, for which our patient was ultimately diagnosed with TLGL leukemia. Proper treatment and control of inflammation in RA are important not only to preserve joint function and vitality but also to prevent rare sequela of untreated autoimmune disorders, as was the case in our patient