244 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0755 Rheumatology
A Case of Gemcitabine-Induced Vasculitis Mimicking Diabetic Muscle Infarction
June Young CHUN1, Jae Myung LEE1, Dong Won AHN1, Jee Won CHAI2, Young A KIM3, Kichul SHIN1
Department of Internal Medicine, Seoul National University Hospital, Korea1, Department of Radiology, Seoul National University Hospital, Korea2, Department of Pathology, Seoul National University Hospital, Korea3
Background: Myopathy or myositis in cancer patients can be related with a number of etiologies and infl ammatory myositis is the primary disease entity of concern. There have also been rare cases of muscle injury caused by cytotoxic agents used in cancer treatment.
Methods: Here we report a case of a 64-year-old male with pancreatic adenocarci- noma and diabetes mellitus on hemodialysis presenting with swelling of his face and right arm. He had been treated with gemcitabine monotherapy for the previous 6 months.
Results: Forearm MRI revealed diffuse swelling of muscles of his right forearm and fi ngers. Muscle biopsy showed marked necrosis of muscle fi bers with infl ammatory cell infi ltration and fi brinoid necrosis in the vascular walls. With discontinuation of gemcitabine, musculoskeletal symptoms resolved spontaneously.
Conclusions: This case advocates that gemcitabine-related musculoskeletal complica- tions are in need to be carefully monitored during its use, especially in patients with underlying small vessel disease or atherosclerosis.
PS 0756 Rheumatology
Pituitary Involvement in Granulomatosis with Polyangi- tis
Hyeon Kyeong JEON1, In Je KIM2, Jisoo LEE2
Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Korea1, Division of Rheu- matology, Ewha Womans University Mokdong Hospital, Korea2
Although Granulomatosis with polyangitis (GPA) can affect any organ system, central nervous system (CNS) is less commonly involved in GPA. CNS manifestations can be result of direct granulomatous infi ltration of brain tissues or by vasculitis of the cere- bral vessels. We report a rare case of posterior pituitary gland involvement in a patient with existing GPA. A 57-year-old woman presented with sudden onset polyuria and polydipsia suggestive of diabetes insipidus. She presented 3 years ago with multiple cranial nerve palsies, nasopharyngeal mass and recurrent sinusitis, and was diagnosed as GPA by biopsy. After induction treatment with cyclophosphamide and prednisolone, she was in remission for 3 years on methotrexate maintenance. Brain MRI fi ndings revealed pituitary gland enlargement and loss of normal neurophysis high signal inten- sity suggesting pituitary involvement by GPA. She was treated with desmopressin and rituximab which resulted in prompt improvement of symptoms.
PS 0757 Rheumatology
A Case of Eosinophilic Granulomatosis with Polyangiitis Combined with Subarachnoid Hemorrhage and Mon- oneuritis Multiplex
Sehwan OH1, Kyong-Hee JUNG1, Won PARK1, Seong Ryul KWON1, Mie Jin LIM1, Ko Woon JOO1, Oh Hyun LEE1, Ha Young LEE2, Se Yang OH3
Department of Internal Medicine, Inha University Hospital, Korea1, Department of Radiology, Inha Univer- sity Hospital, Korea2, Department of Neurosurgery, Inha University Hospital, Korea3
Eosinophilic granulomatosis with polyangiitis (EGPA), which was previously called the Churg-Strauss syndrome, is an ANCA associated vasculitis, accompanied by asthma, hypereosinophilia, nonfi xed pulmonary infi ltrates, and sinusitis. Peripheral neuropathy is common in patients with EGPA. However, a few cases of EGPA with CNS involve- ment have been reported. A 47-year-old female was referred for right side weakness and posterior neck pain. She was diagnosed as EGPA with subarachnoid hemorrhage and mononeuritis multiplex. She was effectively treated with a high dose glucocor- ticoid, cyclophosphamide and intravenous immunoglobulin (IVIG). EGPA with CNS involvement is uncommon and it causes signifi cant morbidity and mortality. Therefore more rapid and accurate diagnostic evaluation may be required. EGPA should be con- sidered while patients have neurological symptoms and hypereosinophilia.
PS 0758 Rheumatology
Predictors of Activation in Patients with Inactive Takayasu’s Arteritis: The Role of Extent of Vascular Involvement
Seokchan HONG1, Seung-Hyeon BAE1, Soo Min AHN1, Doo-Ho LIM1, Yong-Gil KIM1, Chang-Keun LEE1, Bin YOO1
Asan Medical Center, Korea1
Background: The objective of this study was to investigate the clinical outcomes and factors that predict disease activation in patients with clinically inactive Takayasu’s arteritis (TA).
Methods: The medical records of patients diagnosed with TA between 1990 and 2012 were reviewed. At the time of diagnosis, patients were identifi ed as having inactive disease according to the NIH definition. Patients that went on to develop active disease during follow-up were classifi ed as the “activation group”. The pattern of vas- cular involvement was classifi ed according to the International Conference on TA in Tokyo, 1994.
Results: Total 59 TA patients were classifi ed as having inactive disease at the time of diagnosis. During the follow-up period, 13 (22.0%) of these experienced TA activation (median follow-up, 37.0 months; interquartile range (IQR), 23.5–46.5) (activation group). The remaining 46 (78.0%) did not experience disease activation (stable group).
Renovascular hypertension was more common in the activation group than in the stable group (4/13 (38.5%) vs. 4/46 (8.7%); p=0.019). Furthermore, Type V, which is the most extensive, was more common in the activation group (12/13 (92.3%)) than in the stable group (18/46 (39.1%); p=0.008). Multivariate analysis identifi ed Type V disease (odds ratio (OR) = 10.969, confi dence interval (CI), 1.144–105.182; p=0.038) as being signifi cantly associated with an increased risk of disease activation.
Conclusions: Substantial portions of patients with clinically inactive TA at the time of diagnosis experienced disease activation during follow-up. Type V disease may be an important predictive factor for disease activation in patients with clinically inactive TA.
