theMednet - How do you approach an older male with a chronic and persistent granulomatous cutaneous medium vessel vasculitis that has been unresponsive/worsened on high dose steroids, cyclophosphamide, and rituximab immunosuppressive agents with a thorough and unremarkable serologic, infectious, and imaging work-up?

Topics: Rheumatology • Vasculitis

How do you approach an older male with a chronic and persistent granulomatous cutaneous medium vessel vasculitis that has been unresponsive/worsened on high dose steroids, cyclophosphamide, and rituximab immunosuppressive agents with a thorough and unremarkable serologic, infectious, and imaging work-up?

Answer from: at Community Practice

These types of patients vex all rheumatologists at one time or another during the course of clinical practice. The primary concern that is usually raised by a rheumatic disorder unresponsive to therapy is a paraneoplastic disorder. When you say you have a “thorough imaging work-up,” what...

Answer from: at Academic Institution

I'd consider a rebiopsy of the skin looking for an alternate diagnosis if unresponsive to two keystone medications of vasculitis treatment and steroids.

Comments

at Brigham and Women's Hospital, Harvard University
Could he have VEXAS? Also a co fellow of mine rece...

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