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Myeloperoxidase-positive ANCA-associated vasculitis presenting as myalgia, proximal weakness and a normal CK
  1. Mark Peter Maskery1,
  2. Daniel Whittam1,
  3. Subedi Nawaraj2,
  4. Shrijeet Chakraborti3,
  5. Chera Arunachalam4,
  6. Mohammed Munavvar5,
  7. Saifuddin Shaik1
  1. 1Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  2. 2Department of Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  3. 3Department of Pathology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  4. 4Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  5. 5Department of Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  1. Correspondence to Dr Mark Peter Maskery, Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK; mark.maskery{at}lthtr.nhs.uk

Abstract

We describe an unusual presentation of myeloperoxidase positive antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis managed by a multidisciplinary approach. A 75-year-old man gave a 3-week history of proximal lower limb weakness and exertional myalgia. His serum creatine kinase was normal and many of his non-specific symptoms suggested small vessel vasculitis. His investigations for common causes of muscle weakness were normal, and renal biopsy was normal despite haemoproteinuria. CT scan of the chest identified a pulmonary nodule of uncertain significance, not amenable to biopsy. MR scan of the thighs showed muscle oedema, and muscle biopsy confirmed typical features of vasculitis. Following high-dose corticosteroids his exertional myalgia quickly resolved and his normal mobility returned. Early immunosuppression is essential to improving clinical outcomes in ANCA-associated vasculitis, but diagnostic investigations often lack sensitivity.

  • vasculitis
  • histopathology
  • MRI

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Footnotes

  • Contributors All authors contributed equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally reviewed by Jon Walters, Swansea, UK.

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