Large vessel vasculitides

U vaskulitise velikih krvnih žila ubrajamo gigantocelularni i Takayasuov arteritis. Gigantocelularni arteritis najčešći je oblik vaskulitisa u odraslih na koji treba pomišljati u starijih osoba s novonastalom glavoboljom, poremećajima vida, polimijalgijom reumatikom i/ili vrućicom nejasnog uzroka. Glukokortikoidi su osnova liječenja. Takayasuov arteritis je kronični panarteritis aorte i njezinih glavnih grana koji se javlja u mladih osoba. Premda sve velike arterije mogu biti zahvaćene, najčešće su zahvaćene aorta, arterije subklavije i karotidne arterije. Najčešći simptomi su klaudikacije gornjih udova, hipertenzija, bol u području karotida (karotidinija), omaglice i poremećaji vida. Rana dijagnoza i liječenje značajno poboljšavaju ishod bolesti.Large vessel vasculitis includes Giant cell arteritis and Takayasu arteritis. Giant cell arteritis is the most common form of vasculitis affect patients aged 50 years or over. The diagnosis should be considered in older patients who present with new onset of headache, visual disturbance, polymyalgia rheumatica and/or fever unknown cause. Glucocorticoides remain the cornerstone of therapy. Takayasu arteritis is a chronic panarteritis of the aorta ant its major branches presenting commonly in young ages. Although all large arteries can be affected, the aorta, subclavian and carotid arteries are most commonly involved. The most common symptoms included upper extremity claudication, hypertension, pain over the carotid arteries (carotidynia), dizziness and visual disturbances. Early diagnosis and treatment has improved the outcome in patients with TA

Henoch-Schönlein purpura with late-onset necrotising glomerulonephritis - a case report

Henoch-Schönlein purpura (HSP) najučestaliji je oblik sistemskog vaskulitisa u djece, dok je u odraslih rijedak. Klinički se HSP očituje palpabilnom purpurom bez trombocitopenije i/ili koagulopatije, artritisom/artralgijama, bolovima u trbuhu i/ili oštećenjem bubrega. U odraslih bolesnika u usporedbi s pedijatrijskim bubrežna bolest općenito je težeg tijeka, a manifestacije bubrežnog oštećenja najčešće se javljaju u razdoblju od nekoliko dana do mjesec dana od pojave prvih znakova bolesti. U radu smo prikazali 22-godišnju bolesnicu s kožnim vaskulitičnim promjenama i artralgijama u koje je nakon osam tjedana od prvih simptoma prvi put u nalazu urina zabilježena eritrociturija i proteinurija, a biopsijom bubrega utvrđen je nekrotizirajući glomerulonefritis s IgA depozitima. Započeto je liječenje visokim dozama glukokortikoida uz postupno snižavanje doze i postignuta je potpuna remisija bubrežne bolesti. Iz prikaza ove bolesnice zaključujemo da je u bolesnika s HSP-om potrebno praćenje funkcije unutarnjih organa zbog mogućnosti razvoja teškog bubrežnog oštećenja koje se može očitovati i nekoliko mjeseci nakon pojave prvih simptoma bolesti.Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, while it is rare in adults. Typical clinical manifestations include palpable purpura without thrombocytopenia and/or coagulopathy, arthritis/arthralgia, abdominal pain, and/or renal involvement. In adulthood the disease tends to be more serious than in children, with renal manifestations developing over a period of several days to one month after initial symptoms. In this article we present a 22-year-old female patient with cutaneous vasculitis and arthralgia, in whom renal disease developed 8 weeks after disease onset with microscopic hematuria and proteinuria in urinalysis. Renal biopsy subsequently performed revealed focal necrotising glomerulonephritis with IgA deposits. The patient was treated with high dose methylprednisolone followed by gradual tapering, which induced complete remission of the disease. In conclusion, patients with HSP should be carefully monitored for systemic involvement, since serious renal disease can develop even as late as two months after disease onset

Henoch-Schönlein purpura with late-onset necrotising glomerulonephritis - a case report

Henoch-Schönlein purpura (HSP) najučestaliji je oblik sistemskog vaskulitisa u djece, dok je u odraslih rijedak. Klinički se HSP očituje palpabilnom purpurom bez trombocitopenije i/ili koagulopatije, artritisom/artralgijama, bolovima u trbuhu i/ili oštećenjem bubrega. U odraslih bolesnika u usporedbi s pedijatrijskim bubrežna bolest općenito je težeg tijeka, a manifestacije bubrežnog oštećenja najčešće se javljaju u razdoblju od nekoliko dana do mjesec dana od pojave prvih znakova bolesti. U radu smo prikazali 22-godišnju bolesnicu s kožnim vaskulitičnim promjenama i artralgijama u koje je nakon osam tjedana od prvih simptoma prvi put u nalazu urina zabilježena eritrociturija i proteinurija, a biopsijom bubrega utvrđen je nekrotizirajući glomerulonefritis s IgA depozitima. Započeto je liječenje visokim dozama glukokortikoida uz postupno snižavanje doze i postignuta je potpuna remisija bubrežne bolesti. Iz prikaza ove bolesnice zaključujemo da je u bolesnika s HSP-om potrebno praćenje funkcije unutarnjih organa zbog mogućnosti razvoja teškog bubrežnog oštećenja koje se može očitovati i nekoliko mjeseci nakon pojave prvih simptoma bolesti.Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, while it is rare in adults. Typical clinical manifestations include palpable purpura without thrombocytopenia and/or coagulopathy, arthritis/arthralgia, abdominal pain, and/or renal involvement. In adulthood the disease tends to be more serious than in children, with renal manifestations developing over a period of several days to one month after initial symptoms. In this article we present a 22-year-old female patient with cutaneous vasculitis and arthralgia, in whom renal disease developed 8 weeks after disease onset with microscopic hematuria and proteinuria in urinalysis. Renal biopsy subsequently performed revealed focal necrotising glomerulonephritis with IgA deposits. The patient was treated with high dose methylprednisolone followed by gradual tapering, which induced complete remission of the disease. In conclusion, patients with HSP should be carefully monitored for systemic involvement, since serious renal disease can develop even as late as two months after disease onset

Scabies in a Patient with Rheumatoid Arthritis Treated with Adalimumab – A Case Report

Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by synovitis, erosions, and destruction of affected joints. If untreated, it leads to severe disability and premature mortality. Tumor necrosis factor alpha (TNF-α) inhibitors are biological drugs used in treatment of rheumatoid arthritis. Possible side effects include skin allergic reactions, which, if generalized, are the reason for discontinuation of the drug. We report the case of a 46-year-old female patient with rheumatoid arthritis who presented with pruritus and erythematous papular exanthema after administration of the second dose of adalimumab. At first, we suspected a drug hypersensitivity reaction. As the signs and symptoms persisted for 2 months after discontinuation of adalimumab and despite continuous administration of antihistamines and glucocorticoids, further work-up was performed, and scabies was diagnosed. The patient was treated with topical 10% crotamiton. The symptoms were persistent and additional applications of the preparation were needed. After clinical remission of scabies, treatment of active rheumatoid arthritis with adalimumab was restarted without any complications. </p