diagnosis???????

[krishna1033]

A 16-year-old, active, athletic youth was admitted to the hospital in 10/96 for dyspnea at rest and paroxysmal cough. He was healthy until 3 1/2 years before when he began to have intermittent episodes of abdominal discomfort, vomiting, and diarrhea with watery brown stools. Some episodes were followed by swelling of a foot and focal purpura, a biopsy of which showed a leukocytoclastic vasculitis. Laboratory values included WBC 7.4 k/µl, hb 11.3 g/dl, hct 36.3%, plt 542 k/µl, alkaline phosphatase 307 U/L, ALT 102 U/L, and ESR 20 mm/hr. When seen in clinic in late 1994, he appeared healthy (weight 50th centile; height 65th centile). He was afebrile with BP 115/60 mm Hg and HR 68/min. He had no hepatosplenomegaly or abdominal tenderness. There was no blood in the stool, and clubbing was absent. Blood values were unchanged. A gammaglutamyl transferase was 129 U/L; immune complexes were present. Endoscopic retrograde cholangiopancreatography suggested sclerosing cholangitis He had poor weight gain, and intermittent oral aphthous ulcers occurred, but he felt fine between attacks. He was treated with sulfasalazine. Three months later he was admitted for nausea, vomiting and a 9 pound weight loss over 10 days. Temperature was 37.1°, BP 98/60, hb 12 g/dl, plt 510 k/µl, and ESR 27 mm/hr. Liver function tests were normal. A p-ANCA (not anti-myeloperoxidase) was positive. Steroids were begun and then tapered. Other medications included 6-mercaptopurine and sulfasalazine. He was hospitalized two more times for his bowel disease, and responded each time to increased doses of prednisone.


what is the diagnosis?
histopath?
inv of choice?>
assoc HLA?
pretty simple!!!!!!!!
g murali krishna

[Anonymous]

A 16-year-old, active, athletic youth was admitted to the hospital in 10/96 for dyspnea at rest and paroxysmal cough. He was healthy until 3 1/2 years before when he began to have intermittent episodes of abdominal discomfort, vomiting, and diarrhea with watery brown stools. Some episodes were followed by swelling of a foot and focal purpura, a biopsy of which showed a leukocytoclastic vasculitis. Laboratory values included WBC 7.4 k/µl, hb 11.3 g/dl, hct 36.3%, plt 542 k/µl, alkaline phosphatase 307 U/L, ALT 102 U/L, and ESR 20 mm/hr. When seen in clinic in late 1994, he appeared healthy (weight 50th centile; height 65th centile). He was afebrile with BP 115/60 mm Hg and HR 68/min. He had no hepatosplenomegaly or abdominal tenderness. There was no blood in the stool, and clubbing was absent. Blood values were unchanged. A gammaglutamyl transferase was 129 U/L; immune complexes were present. Endoscopic retrograde cholangiopancreatography suggested sclerosing cholangitis He had poor weight gain, and intermittent oral aphthous ulcers occurred, but he felt fine between attacks. He was treated with sulfasalazine. Three months later he was admitted for nausea, vomiting and a 9 pound weight loss over 10 days. Temperature was 37.1°, BP 98/60, hb 12 g/dl, plt 510 k/µl, and ESR 27 mm/hr. Liver function tests were normal. A p-ANCA (not anti-myeloperoxidase) was positive. Steroids were begun and then tapered. Other medications included 6-mercaptopurine and sulfasalazine. He was hospitalized two more times for his bowel disease, and responded each time to increased doses of prednisone.


what is the diagnosis?
histopath?
inv of choice?>
assoc HLA?
pretty simple!!!!!!!!
g murali krishna

Diagnosis - p-ANACA = Polyarteritis Nodosa
Histopath = biopsy of specimen showing small– or medium–sized arteries, or mesenteric arteriography showing microaneurysms or alternating areas of stenosis and dilation. Associated with Hep B and Hep C. Affect any organ but the skin, joints, peripheral nerves, gut and kidney common.

Associated HLA = HLA-DR

[Anonymous]

it was emphasized in our class that pANCA is + in MICROSCOPIC PAN rather than PAN of medium sized arteries...any comments???

[krishna1033]

CAN ANYONE EXPALIN WHY PAN?

DIAGNOSIS IS
INFLAMMATORY BOWEL DISEASE!