Case 3-2003 - A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

doi:10.1056/NEJMcpc020116

Volume 348:333-342		January 23, 2003		Number 4

Case 3-2003 — A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

Jonathan S. Coblyn, M.D., and Robert T. McCluskey, M.D.

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Presentation of Case

A 36-year-old, right-handed man was admitted to the hospitalbecause of seizures and severe hypertension.

The patient had an 18-year history of intravenous drug abuse,including abuse of heroin and cocaine with needle sharing. Oneyear before admission, he discontinued his use of illicit drugsand began to feel vaguely unwell. Three months before admission,tingling developed in the left toes and progressed to numbnessin the foot; these symptoms were accompanied by recurrent vomiting,night sweats, intermittent diarrhea, abdominal pain, subjectivefever, and a weight loss of 16 kg. He noted erythematous lumpsover the shins and ankles; the . . . [Full Text of this Article]

Differential Diagnosis

Classification of the Vasculitides

Classification According to the Size of the Vessel

Classification According to Complement Levels

Cryoglobulinemic Vasculitis

Polyarteritis Nodosa

Clinical Diagnosis

Dr. Jonathan S. Coblyn's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital (J.S.C.), and the Department of Pathology, Massachusetts General Hospital (R.T.M.) — both in Boston.