BMJ case reports
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Case Reports
CMV disease complicating induction immunosuppressive treatment for ANCA-associated vasculitis.
We present a case of a 71-year-old woman who initially presented with renal-limited antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Following standard therapy with cyclophosphamide, steroids and plasma exchange, her renal function began to improve. However, despite appropriate treatment, her renal function subsequently deteriorated and she suffered haemoptysis. ⋯ This resulted in a successful outcome for the patient. Pulmonary CMV disease may mimic pulmonary disease associated with vasculitis, posing a diagnostic challenge to clinicians. We recommend a low threshold when testing for CMV in these patients.
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Haemorrhage is a well-known and accepted complication of anticoagulation. A retropharyngeal haemorrhage (RH) is a rare condition that without prompt recognition and management may result in fatal complications. We report a case of RH in a 67-year-old man anticoagulated with rivaroxaban for atrial fibrillation. ⋯ Despite its rarity, an RH is a potentially life threatening complication of anticoagulation that must be carefully considered. This is especially true for a drug that cannot be easily reversed. We present a discussion of this case presentation with possible differential diagnoses and a review of the literature, and recommend the use of Capp's triad as a diagnostic criterion.
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Haemangiomas are benign tumours of blood vessel origin and are classified as capillary, cavernous or central. They appear as flat or raised reddish-blue lesions and are generally solitary, affecting women in younger age groups. The tumour may be slowly progressive, involving extensive portions of the superficial and deep blood vessels, and affect function, depending on location. ⋯ As the lesion can be confused with pyogenic granuloma, histopathological examination is important for a final diagnosis. The case presented here signifies a rare location of a capillary haemangioma on the palate in a middle aged man. The lesion was diagnosed by histopathology after surgical excision.