The 451th case: intermittent rash, fever and headache

VernacularTitle:临床病例讨论第451例——间断皮疹、发热、头痛
Author: Jiuliang ZHAO ; Yu ZHANG ; Shu ZHANG ; Ji LI ; Qian WANG ; Yan ZHAO ; Xiaofeng ZENG
Publication Type:Journal Article
Keywords: Erythema multiforme; Vasculitis
From: Chinese Journal of Internal Medicine 2016;55(7):578-581
CountryChina
Language:Chinese
Abstract: A 29-year-old woman was admitted to the Department of Rheumatology,Peking Union Medical College Hospital due to intermittent rashes,fever and headache.Palpable purpura were symmetrically distributed on the extremities and trunk.Other manifestations included headache with nausea and vomiting.Elevated white blood cell (WBC) count,platelet (PLT) count,erythrocyte sedimentation rate (ESR) and C-reactive protein were the main laboratory findings.Antinuclear antibodies and antineutrophil cytoplasmic antibodies were negative.Examination of the cerebrospinal fluid (CSF) revealed high intracranial pressure,while routine cytology and biochemical tests of CSF were normal.Head MRI scan and PET-CT did not detect remarkable findings.A diagnosis of systemic vasculitis was confirmed by the biopsy of skin lesion which showed inflammatory infiltration of the muscular vessel wall.Combination therapy of corticosteroids and cyclophosphamide lead to a rapid improvement in clinical symptoms and laboratory parameters.The patient was in stable remission till 6 month follow-up.