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23 June 2019 : Case report  Japan

Unclassified Vasculitis with Episcleritis, Thrombophlebitis, Deep Vein Thrombosis, Pulmonary Vasculitis, and Intracranial Vasculitis: An Autopsy Case Report

Challenging differential diagnosis, Rare disease

Eri Watanabe1ABCDEF*, Akira Tanaka2BDE, Hitoshi Sugawara3ADE, Kumiko Nishina14B, Hiroki Yabe1B, Takahisa Gono1BE, Chihiro Terai1B

DOI: 10.12659/AJCR.915527

Am J Case Rep 2019; 20:886-895

Abstract

BACKGROUND: Systemic vasculitides constitute heterogenous conditions affecting many organs and systems through blood vessel inflammation. Although there are some classifications for vasculitis, several vasculitides are “unclassified” because they cannot be clearly assigned to one of the known entities.

CASE REPORT: We report an autopsy case of a 67-year-old Japanese man who presented with fever, ocular pain, erythema, chest pain, and headache. The disease caused episcleritis, thrombophlebitis, extensive deep vein thrombosis, multiple pulmonary nodules and masses, hypertrophic pachymeningitis, and hyper-intensity areas in brain parenchyma on magnetic resonance images. Histopathology of the pulmonary nodule confirmed vasculitis affecting medium-to-small veins and arteries without necrotizing vasculitis or granulomatous inflammation. We diagnosed the patient with unclassified vasculitis based on the clinicopathological characteristics. Steroids in combination with immunosuppressants were used, but the disease was refractory and relapsing. The disease activity was eventually controlled with rituximab, but the patient died of bronchopneumonia. On autopsy, lung and brain findings indicated healed vascular inflammation.

CONCLUSIONS: This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet’s disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.

Keywords: Arthritis, Multiple Pulmonary Nodules, Phlebitis, Relapsing Fever, Vasculitis, Vasculitis, Central Nervous System, Aged, Autopsy, Fatal Outcome, Scleritis, Thrombophlebitis, Venous Thrombosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923