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flu-like syndrome &#40;92&#37;&#41;&#44; kidney &#40;74&#37;&#41;&#44; skin &#40;46&#37;&#41; and lung &#40;45&#37;&#41;&#46; Fifty to seventy percent of cases have anti-cytoplasmic neutrophil antibodies&#44; associated anti-myelopolymerase &#40;MPO&#41;&#44; with perinuclear &#40;p-ANCA&#41; staining&#46; Outcomes will depend on appropriate treatment according to the severity of the case&#44; with 70&#37; survival at 5 years&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 56-year-old male patient hospitalised at the end of 2012 with a diagnosis of MPA with distal symmetrical PNP of the extremities&#44; positive serology for p-ANCA &#40;1&#58;160&#41;&#44; electromyography with a multiple mononeuritis pattern&#44; and skin biopsy with non-specific vasculitis&#46; On examination he had phlebectasia with plethora and tortuous vessels on the dorsum of the second to fourth fingers of both hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and paresis and hypoaesthesia of fingers and toes with grip and gait limitation&#46; Mild and transient elevation of uraemia and albuminuria with erythrocyturia&#46; He was treated with prednisone&#44; azathioprine and pulse cyclophosphamide&#44; with rapid improvement of the general symptoms and very slow improvement of the neuropathy manifestations&#46; The digital phlebectasia was of a reversible course&#44; and was minimal after 47 months&#8217; follow-up &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; but a mild digital hypoaesthesia persists in the hands and feet&#46; The lab test results are normal&#44; with negative p-ANCA&#46; He continued on a maintenance dose of prednisone and azathioprine&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of MPA was well documented according to the classification of the 2012 Revised International Chapel Hill Consensus Conference Nomenclature<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#59; the peripheral motor and sensory neurological manifestations were relevant due to impairment of the terminal branches of the median&#44; ulnar and peroneal nerves&#44; bilateral&#44; attributable to necrosing vasculitis of the vasa nervorum as a pathophysiological mechanism in MPA&#46; The digital phlebectasia was probably a result of concomitant neurovegetative vasomotor innervation&#44; which subsequently involuted parallel to the sensory-motor neurological symptoms&#46; Ratifying this finding in similar cases it could be given diagnostic value&#44; since it has not been described in PNPs that are metabolic&#44; toxic&#44; infectious&#44; immunological&#44; paraneoplastic&#44; iatrogenic etc&#46; that present with dysautonomia&#44; but at other levels and with different pathophysiologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5&#8211;7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of people and animals</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data confidentiality</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#44; and that the patient gave their informed consent&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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Case report
Phlebectasia in a Finger in a Case of Microscopic Polyangiitis With Peripheral Polyneuropathy
Flebectasia digital en un caso de poliangitis microscópica con polineuropatía periférica
Jorge Julio Badía Floresa,
Corresponding author
jbadia32@gmail.com

Corresponding author.
, Federico G. Arévalo Martínezb
a Coordinación de Reumatología, Hospital Ángeles Mocel, Mexico City, Mexico
b Servicio de Reumatología, Hospital Ángeles Metropolitano, Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Microscopic polyangiitis &#40;MPA&#41; predominantly affects males &#40;1&#46;8&#58;1&#41;&#44; with onset between the ages of 50 and 60 years&#44; with an annual incidence of 2&#46;6&#8211;11&#46;6 cases per million inhabitants and a prevalence of 2&#8211;3 cases per 100&#44;000 inhabitants&#46; The course of the disease is chronic&#44; with the possibility of recurrence&#46; Forty-three percent of cases have neurological impairment&#44; with peripheral polyneuropathy distribution &#40;PPN&#41;&#44; distal and symmetrical with dysaesthesias and digital paresis&#44; principally in the territories of the terminal branches of the peroneal and ulnar nerves&#44; due to vasculitis of the vasa nervorum&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;3</span></a> Other common manifestations are&#58; flu-like syndrome &#40;92&#37;&#41;&#44; kidney &#40;74&#37;&#41;&#44; skin &#40;46&#37;&#41; and lung &#40;45&#37;&#41;&#46; Fifty to seventy percent of cases have anti-cytoplasmic neutrophil antibodies&#44; associated anti-myelopolymerase &#40;MPO&#41;&#44; with perinuclear &#40;p-ANCA&#41; staining&#46; Outcomes will depend on appropriate treatment according to the severity of the case&#44; with 70&#37; survival at 5 years&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 56-year-old male patient hospitalised at the end of 2012 with a diagnosis of MPA with distal symmetrical PNP of the extremities&#44; positive serology for p-ANCA &#40;1&#58;160&#41;&#44; electromyography with a multiple mononeuritis pattern&#44; and skin biopsy with non-specific vasculitis&#46; On examination he had phlebectasia with plethora and tortuous vessels on the dorsum of the second to fourth fingers of both hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and paresis and hypoaesthesia of fingers and toes with grip and gait limitation&#46; Mild and transient elevation of uraemia and albuminuria with erythrocyturia&#46; He was treated with prednisone&#44; azathioprine and pulse cyclophosphamide&#44; with rapid improvement of the general symptoms and very slow improvement of the neuropathy manifestations&#46; The digital phlebectasia was of a reversible course&#44; and was minimal after 47 months&#8217; follow-up &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; but a mild digital hypoaesthesia persists in the hands and feet&#46; The lab test results are normal&#44; with negative p-ANCA&#46; He continued on a maintenance dose of prednisone and azathioprine&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of MPA was well documented according to the classification of the 2012 Revised International Chapel Hill Consensus Conference Nomenclature<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#59; the peripheral motor and sensory neurological manifestations were relevant due to impairment of the terminal branches of the median&#44; ulnar and peroneal nerves&#44; bilateral&#44; attributable to necrosing vasculitis of the vasa nervorum as a pathophysiological mechanism in MPA&#46; The digital phlebectasia was probably a result of concomitant neurovegetative vasomotor innervation&#44; which subsequently involuted parallel to the sensory-motor neurological symptoms&#46; Ratifying this finding in similar cases it could be given diagnostic value&#44; since it has not been described in PNPs that are metabolic&#44; toxic&#44; infectious&#44; immunological&#44; paraneoplastic&#44; iatrogenic etc&#46; that present with dysautonomia&#44; but at other levels and with different pathophysiologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5&#8211;7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of people and animals</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data confidentiality</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#44; and that the patient gave their informed consent&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Paciente masculino de 56 a&#241;os con poliangitis microsc&#243;pica y polineuropat&#237;a perif&#233;rica sim&#233;trica de extremidades con p-ANCA positivo&#44; patr&#243;n EMG de mononeuritis m&#250;ltiple y biopsia cut&#225;nea con vasculitis inespec&#237;fica&#44; quien presentaba flebectasia con pl&#233;tora y trayectos tortuosos en el dorso de los dedos en ambas manos&#44; paresia e hipoestesia digital en manos y pies con limitaci&#243;n funcional&#46; Mediante la administraci&#243;n de prednisona&#44; azatioprina y pulso de ciclofosfamida&#44; mejor&#243; r&#225;pidamente de los s&#237;ntomas generales pero muy lentamente de la neuropat&#237;a&#46; Despu&#233;s de 47 meses de evoluci&#243;n persiste discreta flebectasia digital en manos y ligera hipoestesia en manos y pies&#44; con par&#225;metros de laboratorio normales&#46; La flebectasia&#44; probablemente&#44; fue el resultado de una disautonom&#237;a por vasculitis de la vasa nervorum y podr&#237;a ser un signo a ratificar en casos semejantes&#46;</p></span>"
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ISSN: 21735743
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Idiomas
Reumatología Clínica (English Edition)
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