Tuberculosis mimicking primary systemic vasculitis: not to be missed!

Abstract

Infections are an important differential diagnosis in patients presenting with features of systemic vasculitis. We report a young lady with constitutional features, leg ulcers, digital gangrene and absent peripheral pulses with cervical adenopathy. Chest imaging revealed multiple necrotic lung lesions and involvement of left subclavian artery at its origin from the aorta, Histopathology from cervical lymph nodes showed multiple caseated lymph nodes, which in the context of a positive Mantoux test led us to diagnose tuberculosis and institute appropriate therapy. This is only the second report of tuberculosis presenting as peripheral gangrene, cutaneous ulcers and absent pulses, and serves to educate rheumatologists regarding the need to consider infections as mimics of vasculitis, especially in the developing countries.

Diagnosis and Treatment of Angiography Positive Medium to Large Vessel Childhood Primary Angiitis of Central Nervous System (p-cPACNS): An International Survey

“…Based on participants' responses, most important blood tests include blood cell counts and differentiation (99% both), clotting tests (97% both), immunology profiling (90-95%, including APL, ANA, ANCA, dsDNA, complement function, NMDA/aquaporin antibodies). Additional tests frequently requested included ADA2 levels for the exclusion of DADA2, and IGRA to exclude TBC, as both conditions have been reported to cause neuroinflammation/vasculitis (24,25). Lumbar puncture/CSF analysis was suggested to include CSF opening pressure (85.6 vs. 84.3%), cell counts and protein (98.6 vs. 98.6%), microbiological cultures (93.2 vs. 90.0%), glucose levels (90.5 vs. 92.9%), oligoclonal bands (89.1 vs. 81.4%), lactate (74.3 vs. 78.5%), and NMDA/aquaporin antibodies (68.9 vs. 54.3%).…”