Rheumatoid vasculitis of crural muscles confirmed by muscle biopsy in the absence of inflammatory myopathy: histologic and MRI study

Rheumatol Int. 2010 Aug;30(10):1381-3. doi: 10.1007/s00296-009-1076-3. Epub 2009 Jul 29.

Abstract

A 60-year-old man who had been diagnosed as rheumatoid arthritis admitted to our hospital by dysesthesia on his legs with edema. Nerve conduction velocity test led to diagnosis of mononeuritis multiplex. Magnetic resonance imaging (MRI) of lower legs showed high intensity in slow tau inversion recovery. Typical vasculitis with neutrophil-dominant cell infiltration was observed by muscle biopsy without inflammatory myopathy or fascitis. Diagnosis was made by rheumatoid vasculitis found in crural muscles. Intravenous cyclophosphamide with oral tacrolimus effectively improved dysesthesia with reduction of inflammatory response.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / pathology*
  • Biopsy
  • Cyclophosphamide / therapeutic use
  • Drug Therapy, Combination
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Injections, Intravenous
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Muscle, Skeletal / physiopathology
  • Muscular Diseases / complications
  • Muscular Diseases / pathology*
  • Neural Conduction
  • Neutrophils
  • Paresthesia / complications
  • Paresthesia / drug therapy
  • Paresthesia / pathology
  • Tacrolimus / therapeutic use
  • Treatment Outcome
  • Vasculitis / complications
  • Vasculitis / drug therapy
  • Vasculitis / pathology*

Substances

  • Antirheumatic Agents
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Tacrolimus