RA with ANCA associalted Vasculitis. | Figure 1

RA with ANCA Associated Vasculitis

59-year-old, Female K/c/o - RA on treatment with Mtx, Folvite and Prednisolone presented with Low Grade Fever and Shortness of breath since 15 days and History of hemoptysis. Poor respiratory effort and Respiratory distress.

Multiples petechial lesions all over the body, with edema.

• WBC - 44x10^3
• Neutrophils - 15%
• Eosinophils - 78% (yes, double checked)
• ESR - 5
• PCT < 0.02
• ANCA positive.
• ANA Negative.
• RF positive
• AntiCCP positive
• RFT - S.Creat - 0.8, Proteinuria +
• 24 hour urine Protein to be sent.
• LFT - Normal AST/AST/ALP.
• Albumin - 2.1 g/dl
• Globulin - 3.7 g/dl
• CXR - B/L pleural thickening and calcification
• Bone Marrow - Normoblastic, Eosinophilic (50%)
• BCR/ABL negative.

No H/O asthma or any allergies.
No H/O any helminthic infections
H/O Long term steroids with Cushingoid Facies.

Differential Diagnosis

• ABPA
• Malignancy (Lung, GI etc)
• Superimposed Fungal infection
• ANCA associated Vasculitis
• Rheumatoid Vasculitis.

Thanks in advance.