Clinical History
The patient is a 54-year-old man with lower extremity pain and edema, weakness and fever following a respiratory infection. His past medical history includes gout, hypertension, hyperlipidemia, coronary artery disease status post stents x 2.
Current medications include: atorvastatin and methocarbamol.
Physical exam: bilateral lower extremity edema. MRI of the lower extremities shows bilateral intramuscular and subcutaneous edema. Creatinine kinase level is 200 U/L.
What is your diagnosis?
Active vasculitis with fibrinoid necrosis. Although transmural vessels inflammation and injury is strongly suggestive of vasculitis, fibrinoid necrosis is the diagnostic finding. This is an urgent (if not emergent) diagnosis and should be communicated to the treating physician as soon as possible.
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