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Images in rheumatology
Finger ischaemia, enlarged spleen and lung nodules
  1. Xavier Puéchal,
  2. Laure Delaval,
  3. Philippe Blanche
  1. National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
  1. Correspondence to Dr Xavier Puéchal, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, 75014 Paris, France; xavier.puechal{at}aphp.fr

https://doi.org/10.1136/ard-2023-224161

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    A 48-year-old man presented with a 10 kg weight loss and fever. On examination, there was digital ischaemia (figure 1), oedema of the lower extremities and absence of heart murmur. Laboratory investigation showed anaemia with a haemoglobin concentration of 96 g/L, thrombocytosis (995 Giga/L) and raised cardiac troponin T values (10 500 ng/L; normal 0–14). Howell-Jolly bodies were present on a blood smear (nuclear remnants found in red blood cells consistent with hyposplenism). Kidney function was normal with a serum creatinine level of 56 µmol/L, but the patient had haematuria on urine examination. PR3-ANCA was detected at 120 U/mL (normal 0–20). Cardiac investigations revealed no arrhythmias, endocarditis, intracardiac thrombus or coronary artery disease, but a 40% …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors XP: design, acquisition and interpretation of the work, drafting of the work and approval of the final version. LD: acquisition and interpretation of the work, drafting of the work and approval of the final version. PB: design, acquisition and interpretation of the work, drafting of the work and approval of the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.