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Unusual association of diseases/symptoms
Systemic vasculitis: a dual diagnosis?
  1. Eliza Gil1,
  2. Pamela Lutalo2,
  3. David D’Cruz2
  1. 1Care of the elderly, University College Hospital, London, UK
  2. 2Louise Coote Lupus Unit, St Thomas’ Hospital, London, UK
  1. Correspondence to Dr Eliza Gil, eliza.gil2{at}


The authors describe a 25-year-old male with systemic vasculitis fulfilling the American College of Rheumatology classification criteria for both granulomatosis with polyangiitis (Wegener’s granulomatosis) and polyarteritis nodosa. The patient was diagnosed with granulomatosis with polyangiitis following a mediastinal biopsy which revealed necrotising granulomas of the large airways, a positive cytoplasmic antineutrophil cytoplasmic antibodies and high antiproteinase 3 antibody titre. He then developed acute right-sided abdominal and testicular pain as well as areas of hyperaesthesia and parasthesiae on both lower limbs. He was found to have focal crescentic glomerulonephritis and mononeuritis multiplex, in keeping with his diagnosis of granulomatosis with polyangiitis, as well as two areas of infarction in his right testicle and multiple aneurysms of his hepatic and right renal arteries, more typical of polyarteritis nodosa. His symptoms developed 6 weeks after hepatitis B vaccination, which may have played an aetiological role.

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  • Competing interests None.

  • Patient consent Obtained.

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