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A 60-year-old man was evaluated in the rheumatology clinic because of a rash and worsening renal function.
He had been well until three months earlier, when he began to have fatigue and weight gain, one week after returning from a visit to his son in Colorado. He could not fit into his shoes, and his wife noticed that he had facial swelling. Three days later, a rash appeared over his buttocks and feet. He saw his primary care physician. The blood pressure was 154/82 mm Hg. There was 1+ bilateral pretibial and pedal edema. Tests for antineutrophil cytoplasmic antibodies and
Differential Diagnosis
Clinical Diagnosis
Dr. Jonathan Kay's Diagnosis
Pathological Discussion
Discussion of Management
Anatomical Diagnosis
Source Information
From the Rheumatology Unit (J.K.) and the Department of Pathology (R.T.M.), Massachusetts General Hospital; and the Departments of Medicine (J.K.) and Pathology (R.T.M.), Harvard Medical School — both in Boston.
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