Predicament of classification: Multisystem small vessel vasculitis with cresentic Glomerulonephritis

Abstract

Case HistoryThe patient is a 28-year old Caucasian man with six month history of arthralgia and crampy abdominal pain who presented with acute dyspnea and cough for 6 months associated with migratory polyarthralgias involving his knees, ankles, wrists, and shoulders. Three months prior to admission he noted an episodic crampy abdominal pain with intermittent diarrhea and constipation. The arthralgia persisted and was more associated with two hours of morning stiffness. During this time he also noted occasional nose bleeds and dif icult hearing out of his left ear.He was seen in the emergency department with the above complaints. Physical examination showed no evidence of joint swelling or erythema and his laboratory evaluation is seen in table 1.