Systemic vasculitis or not? That is the question

• Published in: Annals of the rheumatic diseases Vol. 58; no. 10; pp. 591 - 594
• Main Authors: Kontogiannis, Vlassis, Havlat, Marek, Lowe, James S, Powell, Richard J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.10.1999; BMJ; BMJ Publishing Group LTD
• Subjects: Anticoagulants; Biological and medical sciences; Bone marrow; Cytotoxicity; Drug dosages; Enzymes; Family medical history; Fever; Hepatitis; Lesson of the Month; Liver; Medical imaging; Medical sciences; Sarcoidosis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; systemic vasculitis; Tomography; Tuberculosis; Ultrasonic imaging; Human; Nervous system diseases; Central nervous system; Cardiovascular disease; Vascular disease; Case study; Symptomatology; Treatment; Vasculitis; Systemic disease; Central nervous system disease; Primary; Adult
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.58.10.591

Smear examination of a stereotactic brain biopsy from the left frontal lobe, rather than confirming a glioma, revealed a granulomatous inflammatory process and as tuberculosis could not be excluded, triple therapy was started (isoniazid, rifampicin, pyrazinamide) and samples sent for microbiology. Granulomatous vasculitis occurs in less than 50% of biopsies. 1 It represents a diagnostic problem and should be considered in patients with unexplained headaches, focal or diffuse neurological deficits, behavioural changes, or myelopathy.\n The vasculitic rash on the lower legs led to the consideration of a systemic vasculitis rather than PACNS. The rationale for the use of co-trimoxazole is based on our own published experience in connective tissue diseases 14 and the subject has recently been reviewed. 15 Sarcoidosis is another disease that can affect the CNS and involve other organs but in CNS sarcoidosis vascular involvement is virtually unknown, 7 necrosis is generally absent and there is a tendency to involve the base of the brain. 3 Liver dysfunction in sarcoidosis is unusual and the subsequent response to discontinuing carbamazepine was revealing.