Large vessel vasculitis with rare presentation of acute rhabdomyolysis:A case report and review of literature  

作　　者：Lan-Jun Fu Shou-Ci Hu Wen Zhang Li-Qing Ye Hong-Bo Chen Xiao-Jun Xiang 

机构地区：[1]Department of Nephrology,The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Traditional Chinese Medicine),Hangzhou 310006,Zhejiang Province,China

出　　处：《World Journal of Clinical Cases》2022年第13期4137-4144,共8页世界临床病例杂志

基　　金：Supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2021KY833;Traditional Chinese Medical Science and Technology Project of Zhejiang Province,No.2021ZB110.

摘　　要：BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.

关 键 词：Large vessel vasculitis RHABDOMYOLYSIS Giant cell arteritis 18F-fluorodeoxyglucose-positron emission tomography/computed tomography Immunosuppressive treatment Case report 

分 类 号：R543[医药卫生—心血管疾病] R685.5[医药卫生—内科学]