P-ANCA vasculitis with diffuse alveolar haemorrhage preceded by a spider bite

Ali Hameed Ali; Mandip Singh Kang; Jaafar Aldahwi; Candice Reyes

doi:10.1136/bcr-2019-233710

P-ANCA vasculitis with diffuse alveolar haemorrhage preceded by a spider bite

BMJ Case Rep. 2020 Jun 17;13(6):e233710. doi: 10.1136/bcr-2019-233710.

Authors

Ali Hameed Ali¹, Mandip Singh Kang², Jaafar Aldahwi³, Candice Reyes⁴

Affiliations

¹ Internal Medicine, UCSF, Fresno, California, USA.
² Internal Medicine, UCSF, Fresno, California, USA [email protected].
³ VA Medical Center Fresno, Fresno, California, USA.
⁴ Internal Medicine, UCSF Fresno Center for Medical Education and Research Edward and Ann Hildebrand Medical Library, Fresno, California, USA.

Abstract

We report a patient with antineutrophilic cytoplasmic antibody (ANCA) vasculitis that was preceded by witnessed black widow spider bites. The patient initially presented with a diffuse painful skin rash that developed after a few hours post bite. He was treated initially with topical ointment for the suspected bite. However, subsequently a few days later the patient returned to the hospital with similar, but more progressive rash with haemoptysis and acute hypoxic respiratory failure requiring supplemental oxygen. Immunology work up showed elevated titre of peri-nuclear ANCA. Bronchoscopy revealed diffuse alveolar haemorrhage. The patient was treated successfully with methylprednisolone and rituximab.

Keywords: dermatological; vasculitis.

Publication types

Case Reports

MeSH terms

Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / etiology*
Hemorrhage / etiology*
Humans
Lung Diseases / etiology*
Male
Pulmonary Alveoli / pathology
Spider Bites / complications*