Images in Clinical Rheumatology
‘Vasculitic lung lesions’ – Don’t forget the heart!
‘Lesiones pulmonares vasculíticas’ – ¡No olvides el corazón!
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "621" "paginaFinal" => "622" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joydeep Samanta, Arghya Chattopadhyay, Varun Dhir" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Joydeep" "apellidos" => "Samanta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Arghya" "apellidos" => "Chattopadhyay" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Varun" "apellidos" => "Dhir" "email" => array:1 [ 0 => "varundhir@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Senior Resident, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Additional Professor, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "‘Lesiones pulmonares vasculíticas’ – ¡No olvides el corazón!" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2135 "Ancho" => 2610 "Tamanyo" => 740385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Contrast enhanced computed tomography of chest showed multiple irregular nodules in both lung with central cavitation and surrounding consolidation. (C and D) Transthoracic echocardiography showing ventricular septal defect with two vegetations on non-coronary cusp and right side of interventricular septum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 55-year-old-woman, presented with complaints of exertional dyspnea for 6 months, numbness of legs for 4 months and low-grade intermittent fever for 2 months. She had a ventricular septal defect (VSD) first detected 20 years ago. Examination revealed a pansystolic murmur in neoaortic area, slightly decreased power in right lower limb, but normal deep tendon reflexes. Blood tests revealed moderate anaemia, high erythrocyte sedimentation rate and elevated C-reactive protein. Contrast enhanced computed tomography of chest showed multiple irregular nodules in both lung with central cavitation and surrounding consolidation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). Her blood cultures were sterile, nerve conduction study showed right peroneal motor axonal neuropathy, and transthoracic echocardiograph showed moderate VSD, mild aortic and mitral regurgitations but no vegetations. Anti-neutrophil cytoplasmic (ANCA) vasculitis was considered a strong possibility, however, ANCA against proteinase 3 and myeloperoxidase was negative. In this scenario, a reassessment of possibilities and applying Occam's razor, infective endocarditis was reconsidered, and transesophageal echocardiography revealed moderate VSD (9<span class="elsevierStyleHsp" style=""></span>mm) with left to right shunt, one mobile vegetation (10.7<span class="elsevierStyleHsp" style=""></span>mm) on non-coronary cusp of the aortic valve and one on (11.6<span class="elsevierStyleHsp" style=""></span>mm) right side of inter-ventricular septum with severe aortic regurgitation (1C and D). A diagnosis of infective endocarditis with septic pulmonary embolism was made. She received four weeks of parenteral antibiotics, followed by repair of VSD, aortic valve replacement and mitral valve repair, and is doing well. Infective endocarditis (especially culture negative) can often masquerade as vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Consent</span><p id="par0010" class="elsevierStylePara elsevierViewall">Written consent has been obtained from the patient for the publication.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial disclosures/funding sources</span><p id="par0015" class="elsevierStylePara elsevierViewall">None of the authors has any financial disclosure or funding sources.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Consent" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial disclosures/funding sources" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-01-13" "fechaAceptado" => "2022-02-03" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2135 "Ancho" => 2610 "Tamanyo" => 740385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Contrast enhanced computed tomography of chest showed multiple irregular nodules in both lung with central cavitation and surrounding consolidation. (C and D) Transthoracic echocardiography showing ventricular septal defect with two vegetations on non-coronary cusp and right side of interventricular septum.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infective endocarditis mimics ANCA associated glomerulonephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Reza Ardalan" 1 => "M. Trillini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Caspian J Intern Med" "fecha" => "2012" "volumen" => "3" "paginaInicial" => "496" "paginaFinal" => "499" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Sugiyama" 1 => "M. Sahara" 2 => "Y. Imai" 3 => "M. Ono" 4 => "K. Okamoto" 5 => "K. Kikuchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000228645" "Revista" => array:6 [ "tituloSerie" => "Cardiology" "fecha" => "2009" "volumen" => "114" "paginaInicial" => "208" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19602882" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001800000010/v1_202211240631/S1699258X22000481/v1_202211240631/en/main.assets" "Apartado" => array:4 [ "identificador" => "42683" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Reumatología clínica en imágenes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001800000010/v1_202211240631/S1699258X22000481/v1_202211240631/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22000481?idApp=UINPBA00004M" ]
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