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Vol. 15. Issue 6.
Pages 368-369 (November - December 2019)
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Vol. 15. Issue 6.
Pages 368-369 (November - December 2019)
Case report
DOI: 10.1016/j.reumae.2018.10.011
Phlebectasia in a Finger in a Case of Microscopic Polyangiitis With Peripheral Polyneuropathy
Flebectasia digital en un caso de poliangitis microscópica con polineuropatía periférica
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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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Abstract

The patient was a 56-year-old man with microscopic polyangiitis and symmetrical peripheral polyneuropathy of the extremities who was positive for p-ANCA, EMG pattern of mononeuritis multiplex and skin biopsy showing the presence of nonspecific vasculitis. He had phlebectasia with plethora and tortuous vessels on dorsum of the fingers on both hands, paresis and hypoesthesia of fingers and toes with functional limitations. The administration of prednisone, azathioprine and a cyclophosphamide pulse achieved rapid improvement in the general symptoms, but the changes in the neuropathy occurred very slowly. After 47 months of treatment, he had mild phlebectasia in fingers and slight hypoesthesia in hands and feet, with normal laboratory tests. Phlebectasia was probably the result of an autonomic dysfunction due to vasculitis of the vasa nervorum and could be a sign to look for in similar cases.

Keywords:
Microscopic polyangiitis
Peripheral polyneuropathy
Fingers phlebectasia
Resumen

Paciente masculino de 56 años con poliangitis microscópica y polineuropatía periférica simétrica de extremidades con p-ANCA positivo, patrón EMG de mononeuritis múltiple y biopsia cutánea con vasculitis inespecífica, quien presentaba flebectasia con plétora y trayectos tortuosos en el dorso de los dedos en ambas manos, paresia e hipoestesia digital en manos y pies con limitación funcional. Mediante la administración de prednisona, azatioprina y pulso de ciclofosfamida, mejoró rápidamente de los síntomas generales pero muy lentamente de la neuropatía. Después de 47 meses de evolución persiste discreta flebectasia digital en manos y ligera hipoestesia en manos y pies, con parámetros de laboratorio normales. La flebectasia, probablemente, fue el resultado de una disautonomía por vasculitis de la vasa nervorum y podría ser un signo a ratificar en casos semejantes.

Palabras clave:
Poliangitis microscópica
Polineuropatía periférica
Flebectasia digital

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