[The case of immunologic vasculitis which was treated as a hypochondriac disorder]

The long and difficult diagnostic and therapeutic process in a 21 year old patient with hypochondriac disorder was presented. In the past he had the streptococcal throat infection and during 5 years he was diagnosed and treated because of headache, heart, muscles and joints pains. His blood pressure was occasionally high. He had tonsillectomy and his ASO index was high (from 405 IU/ml to 2500 IU/ml). His cranial CT, EEG, ECG were normal. Finally he was diagnosed as having hypochondriac disorder and began psychiatric treatment. Because of lacking improvement in the out-patient therapy he was admitted to the Neurotic Ward of Medical Academy in Gdańsk. The results of cerebral SPECT showed hypoperfusion in different regions (prefrontal, frontal, temporal, parietal, about medial from 5-22%). The antibodies ABA type II/20/, ACA/ CA/ type III /10/, MSA /ASMA/++/ were found. The level of thrombomodulin was 36.64 ng/ ml. Psychological tests (Benton, Bender, MMPI) were normal. In result of the above findings and observation the diagnosis was changed from hypochondriac disorder to secondary immunologic vasculitis. The patient received probably the possibility to be properly treated.