An atypical lower limb pain revealing a possible systemic venous vasculitis

Abstract

We describe a possible systemic vasculitis involving electively large veins. The patient presented with severe febrile lower limb pain. Diagnosis was made by color Doppler ultrasound (CDU) and confirmed by anatomopathological examination of the long saphenous vein, but not by examination of the temporal artery which was normal. CDU found a unilateral halo sign of one temporal artery and a major wall swelling of the lower limb proximal deep veins. The etiology of this possible vasculitis is still unknown. It could be an unusual clinical presentation of giant cell arteritis with vein involvement but without proven arterial involvement. To confirm this hypothesis, it would be interesting to look systematically for lower limb vein thickening with CDU in patients newly diagnosed with giant cell arteritis who have lower limb pain.

Ultrasound imaging of the dorsalis pedis artery as an early indicator of the precursory changes for rheumatoid vasculitis: A case series

“…24 Medical imaging is non-invasive and can identify vasculitis in medium-to large-vessel disease, but is limited to the mid to late stages of the disease. 25,26 Similarly, non-invasive B-mode ultrasound imaging can also assist in the diagnosis of vasculitis in medium-to-large arteries in the mid to late stages with the depiction of the classic halo sign. 27 Colour and spectral Doppler changes can also demonstrate increased arterial blood velocities, which indicate further changes to the function of the artery in the mid to late stages of vasculitis.…”

“…Currently, tissue biopsy is the gold standard for vasculitis diagnosis but is limited in accuracy in later disease, 23 with poor prognosis 24 . Medical imaging is non‐invasive and can identify vasculitis in medium‐ to large‐vessel disease, but is limited to the mid to late stages of the disease 25,26 . Similarly, non‐invasive B‐mode ultrasound imaging can also assist in the diagnosis of vasculitis in medium‐to‐large arteries in the mid to late stages with the depiction of the classic halo sign 27 .…”