Tue, Mar 01, 2016 - Page 3 News List

Doctors encourage vasculitis checkups for at-risk patients

DIFFICULT DIAGNOSIS:Disorders that constitute vasculitis can first present in different ways, making the condition difficult to diagnose, a physician said

By Lee I-chia  /  Staff reporter

Physicians said vasculitis — inflammation that causes the destruction of blood vessels — can progress rapidly, but is often difficult to diagnose, urging people who repeatedly exhibit symptoms including fever, coughing up blood, blood in their urine and sinusitis without cause to have an examination performed by a department of allergy, immunology and rheumatology at a hospital.

In one case, a man in his 20s suffering from a high fever was misdiagnosed as having tuberculosis after a chest X-ray found irregularities in his lung nodules. He was taken to Kaohsiung Medical University Chung-Ho Memorial Hospital’s Department of Infectious Diseases, but medication prescribed by a doctor did not improve his condition.

It was then suspected the man had other diseases, and he was hospitalized for further examinations. Doctors suspected excessive alcohol consumption, drug use and even HIV, as the man had recently returned from trips to Sri Lanka and Africa, but were unable to find the cause of his illness after a month.

He was later transferred to the department of allergy, immunology and rheumatology due to joint pain from arthritis. It was there that he was diagnosed with anti-neutrophil cytoplasmic antibody-associated vasculitis.

Physician Ou Tsan-teng (歐燦騰), who treated the patient, said making a vasculitis diagnosis is often difficult, because the disorders that constitute vasculitis can first present in a number of different ways, including fever, coughing up blood, blood in urine, sinusitis, skin rashes or purple or red discoloration of the skin.

New Taipei City-based Far Eastern Memorial Hospital physician Wu Chien-sheng (吳建陞) said vasculitis can result from the immune system attacking blood cells, causing blood vessels to become inflamed, damaged — which can trigger inflammatory cell infiltration and thickened blood vessel walls — and become narrow — even to the point of closing entirely.

If inflammation occurs in small blood vessels in the lungs, kidneys, skin or nervous system, symptoms can be relatively complicated, Wu said, adding that some patients even feel numbness or weakness in their extremities due to peripheral neuropathy, when nerves are affected by damage or disease.

What happened to the young man was not an isolated case, Wu said, adding that he once had a female patient in her 50s with symptoms that were first thought to be related to tuberculosis, and only through extensive examination was she eventually determined to have vasculitis.

Although vasculitis presents several diagnostic challenges, if patients can be accurately diagnosed at an early stage, treatment is not difficult, Ou said, adding that medicines covered by the National Health Insurance program have shown therapeutic effects.

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