"Fleshy" Skin Cellulitis: A Triggering Factor for ANCA Associated Vasculitis

Area of Science:

• Internal Medicine
• Nephrology
• Rheumatology

Background:

• Hypothyroidism is an endocrine disorder with potential autoimmune associations.
• Cutaneous infections can lead to systemic complications.
• ANCA-associated vasculitis (AAV) is a group of rare autoimmune diseases.

Observation:

• A 59-year-old woman with hypothyroidism developed acute contact dermatitis progressing to cellulitis and bacterial infection.
• The patient subsequently developed cutaneous and systemic vasculitis, confirmed as leukocytoclastic vasculitis.
• Blood tests revealed cytoplasmic-anti-neutrophil cytoplasmic antibody (c-ANCA) positivity.

Findings:

• The patient was diagnosed with ANCA-associated vasculitis.
• Treatment included immunosuppressants, plasmapheresis, and hemodialysis for acute kidney injury.
• Despite aggressive management, the patient's condition was fatal.

Implications:

• This case suggests that soft tissue infections may precipitate AAV in susceptible individuals.
• Hypothyroidism might act as a predisposing factor for developing AAV.
• Highlights the need for vigilance in patients with hypothyroidism presenting with infections.