Hepatitis C Associated with Polyarteritis Nodosa Bindiya Magoon, MD ACP Associate member, Elias Ghandour, MD, Good Samaritan Hospital, Baltimore, Maryland.

Slides:



Advertisements
Similar presentations
David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C.
Advertisements

Unusual Brain Lesion with a Usual Cause
”FIRST AND FINEST” Lupus Enteritis: A Pain in the Gut LT James Prim, DO LCDR Shauna O’Sullivan, DO Naval Medical Center Portsmouth.
Heather D. Mannuel, MD, MBA March 12, 2008
KERRIE TIDWELL – MS 3 RED MR. What is the diagnosis? Case Report 1  35 yo AAF c/o new rashes on extremities  PE: Diffuse palpable purpura in reticular.
U # month history of being unwell Vasculitic lesions on lower limbs ANCA positive Likely Wegener’s vs MPA.
Hatem Eleishi, MD Rheumatologist STILL’S DISEASE.
NYU Medical Grand Rounds Clinical Vignette Neelja Kumar, MD PGY 3 October 20, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Dyspnea and Rash Andres Quiceno, MD Rheumatology PHD.
A Young Male With Idiopathic Hepatic Encephalopathy And A Necrotic Lower Extremity Evan D. Schmitz, M.D. Pulmonary & Critical Care Fellow Carl T. Hayden.
Resident Report Wegener’s Granulomatosis Small vessel vasculitis Typical areas affected are sinus, upper airway, lungs, kidney Progressive course.
Acute liver failure Tutorial Ayman Abdo MD, FRCPC.
Vasculitis and connective tissue disease – just a taster!! The common and the rare!!
Objectives What is a vasculitis Know the more common and relevant vasulitides. Understand how to investigate and manage these conditions. Case scenario.
Vasculitis Hisham Alkhalidi.
Antiphospholipid antibody syndrome due to interferon  treatment for hepatitis C Michi Shinohara, MD Pacific Dermatologic Association August 10, 2008.
Department of Medicine Grand Rounds Clinical Vignette Ilana Bragin January 14 th, 2009 NYU Langone Medical Center Internal Medicine Residency Program.
WEGENER’S GRANULOMATOSIS
Immunoglobulin A Nephropathy as a Systemic Underlying Cause of Bilateral Anterior Scleritis Aruoriwo Oboh-Weilke, MD Florian A. Weilke, MD InnovisHealthFargo,ND.
Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine
NYU Medical Grand Rounds Clinical Vignette Matthew B. Brown M.D. PGY-2 10/4/11 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
A 25 year old farmer with joint pain Laura Zakowski, MD* * No financial disclosures.
NYU Medical Grand Rounds Clinical Vignette Lucy Doyle MD, PGY-2 March 24, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Vasculitis Sufia Husain Pathology Department KSU, Riyadh March 2014.
NYU Medical Grand Rounds Clinical Vignette Laura Van Metre Baum, MD Class of 2013 Tuesday, April 17, 2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Nephrology Diseases & Chemotherapy. Idiopathic Nephrotic Syndrome (NS) Caused by renal diseases that increase the permeability across the glomerular filtration.
Case Study 7 Craig Horbinski, M.D, Ph.D.. History 63-year-old male with generalized progressive weakness especially in his lower extremities with difficulty.
JCM OSCE Questions Caritas Medical Centre 3 June, 2015.
NYU Medical Grand Rounds Clinical Vignette Phillip Joseph, MD, PGY-2 September 25 th, 2013 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Vasculitis Vasculitis arises when immune system mistakenly attacks blood vessels. What causes this attack isn't fully known, but it can result from infection.
NYU Medical Grand Rounds Clinical Vignette NYU Medical Grand Rounds Clinical Vignette Michael Chu MD, PGY-2 5/20/09.
Department of Medicine Grand Rounds Clinical Vignette Wednesday, March 4, 2009 Peter Shue, M.D.
Int J MS Care 7: , 2005/2006. Jan 9 & 10, Clinical Stabilization of a MS Patient after Tonsillectomy presented by Michael C. Levin, MD Department.
Severe vascular lesions and poor functional outcome
HERPES SIMPLEX ENCEPHALITIS ENCEPHALITIS M.RASOOLINEJAD, MD DEPARTMENT OF INFECTIOUS DISEASE TEHRAN UNIVERCITY OF MEDICAL SCIENCE.
Diagnostic Approach to Vasculitis
U # ↑ SG 300. Proteinuria, Vasculitis rash. Native (L) Kidney.
Interstitial nephritis associated with PostInfectious GN PRAET MARLEEN, MD, PhD UNIVERSITY HOSPITAL GHENT.
RHEUMATOID VASCULITIS Kamal Kolappa UNC Internal Medicine Morning Report
NYU Medical Grand Rounds Clinical Vignette Matko Kalac, MD PGY-2 9/18/2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
NYU Medicine Grand Rounds Clinical Vignette James Kim, M.D., PGY-2 February 26, 2014 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
REGISTRAR: DR GS HURTER CONSULTANT: DR JCJ VAN VUUREN FIRM: 3 MILITARY HOSPITAL ATYPICAL MANIFESTATION OF HEPATITIS A.
Internal medicine cases
A 30-year male with cognitive decline and unsteady gait Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.
When you hear hoofbeats… Nancy Fuller, M.D. Nov 28, 2007.
54 year old man with 7 grams/day proteinuria Microscopic hematuria and serum creatinine nearly 130. He is HCV positive and had received liver transplant.
Acute Liver Failure Tutorial Ayman Abdo. Objectives After the discussion in this educational exercise, I want you to be able to : Identify common causes.
Celiac Disease: Neurological Manifestations in 2 undiagnosed patients Kogulavadanan Arumaithurai MD, Ashish Kapoor MD, Holli Horak MD, Katalin Scherer.
RHEUMATOID ARTHRITIS (RA). Introduction RA is a chronic, systemic inflammatory disorder of unknown etiology characterized by the manner in which it involved.
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that usually involves the lungs, upper respiratory tract and kidneys. Common presentations.
Recurrence of Henoch-Schonlein purpura nephritis after 6.5 years of remission- an unusual clinical occurrence Vignesh Pandiarajan*, Deepti Suri*, Anju.
Renal vascular disease
Nivin Haroon, MD and Erdal Sarac, MD
A. Karki1, V. Patel2, K. Sherani3,J. Raynor3, K. Mandal3, A. Shalonov3 
ACUTE VIRAL HEPATITIS CLINICAL PRESENTATION. DIGNOSIS.
Acute hepatitis of uncertain cause, rule out EBV related
Wilson’s Disease.
Non-alcoholic steatohepatitis with positive ANA
Alcoholic foamy degeneration with early alcoholic cirrhosis
Acute viral hepatitis type C
Chapter 3 Fatty Liver Diseases 1 Alcoholic steatosis Case 3.1.
Alcoholic hepatitis with diffuse interstitial fibrosis
Chapter 14 Hepatic Tumors, Malignant 1
Oregon Health and Science University
IgA Nephropathy Southwest Nephrology Symposium February 24th 2018.
Giant Cell Arteritis and Polymyalgia Rheumatica Definition
Nephrology cases Dr . Hayam Hebah.
CLINICAL SOLVING PROBLEM
A 12-month-old girl with chronic infarction in bilateral middle cerebral artery territories. A 12-month-old girl with chronic infarction in bilateral middle.
Presentation transcript:

Hepatitis C Associated with Polyarteritis Nodosa Bindiya Magoon, MD ACP Associate member, Elias Ghandour, MD, Good Samaritan Hospital, Baltimore, Maryland. Introduction: Cryoglobulinemia-associated vasculitis is very well known to be associated with Hepatitis C infection (HCV). However, a Polyarteritis Nodosa type illness (PAN) is relatively uncommon and only few cases have been reported in the literature. We report a case of Hepatitis C presenting as PAN. History: A 50- year old Caucasian male presented to the hospital with arthalgias, myalgias, marked asymmetric weakness progressively worsening over 3 months of both upper and lower extremities causing ataxia and physical disability. His history was also significant for a 50 pound weight loss, recurrent episodes of abdominal pain, polyuria, and polydipsia. His past medical history included bipolar disorder and alcoholism. Physical exam: Patient was cachetic and emaciated. Vitals were unremarkable. He had bilateral foot drop and right wrist drop with sensory loss to all modalities over both feet, suggestive of mononeuritis multiplex. Labs and Imaging: Hb-12, Hct-35%, Wbc- 8200, BUN-27, Cr-2.2 (increased over time to 4.2), AST-95, ALT-60. Urine- Pr-1+, RBC-0. Hepatitis C Ab positive, Hep C RIBA positive, HIV negative, HbsAg negative, SPEP- Increased Gamma globulins with polyclonal pattern. ANA positive with speckled pattern, Cryoglobulins (repeated samples) Negative. Renal Bx- Small and medium vessel vasculitis, with interstitial nephritis; negative for Cryoglobulins. All other serologies were negative. Hosptal Course: Due to worsening renal function with negative serologies, the patient underwent renal biopsy, which showed medium and small vessel vasculitis. His clinical course was also complicated by generalized seizures. MRI findings were consistent with cerebritis. He was initially pulsed with steroids and started on maintenance dose of cyclophosphamide and prednisone. There was progressive improvement in muscle weakness and neuropathy, with no further seizures. However, there was no improvement in renal function, and the patient eventually required initiation on hemodialysis. Conclusion: Although Hepatitis C infection is classically associated with cryoglobulinemic vasculitis, polyarteritis nodosa-type vasculitis should be considered. Markers for Hepatitis C have been found in 5-12% of patients with PAN. Differentiation between polyarteritis nodosa and cryoglobulinemic-type vasculitis can be difficult because both diseases share close clinical manifestations and pathologic lesions. ANCA is also rare in both conditions and fails to contribute to the diagnosis. However, some features found in HCV- infected patients with PAN vasculitis have not been reported in cryoglobulin disease such as micro- aneurysms and renal cortical necrosis secondary to occlusion of medium-size arteries. The mechanisms that cause PAN type vasculitis are unclear. References: 1.Cacoub P, Maisonobe T, Thibault V, et al. Systemic vasculitis in patients with hepatitis C J Rheumatol 2001;28:109–18. 2.Polyarteritis nodosa and cryoglobulinemic glomerulonephritis related to chronic hepatitis C. Canada R, Chaudhary S, Gaber L, Waters B, Martinez A, Wall B. Am J Med Sci Jun;331(6): Interstitial Nephritis Medium Vessel Vasculitis Medium vessel Vasculitis