Clinical History:

A 69-year-old woman had a 30 year history of rheumatoid arthritis. She had been treated with steroids, salicylates and surgery for joint deformities. About one month prior to death she developed neuritis with pain and muscle weakness. Treatment at that time included prednisone and non-steroidal inflammatory drugs. After initial improvement she had worsening neuritis and high dose prednisone was started. She was found to have proteinuria. About a month later she had a cardiorespiratory arrest.

Sections of her coronary arteries are shown in slides Figure 1,  Figure 2 and Figure 3.

Questions:

1. Describe the histologic features. What is your diagnosis? Blood vessels throughout her body were similar.

2. What other symptoms and signs might be related?

3. What complications of her therapy might be expected?

4. What was the probable cause of death?

5. What is the pathogenesis of the disease process?

ANSWERS

||  Case 1  ||  Case 2 ||  Case 3  ||  Case 5 ||  Case 6  ||  Case 7  ||   Case 8  ||  Case 9  ||  Case 10  ||