case_images: PMC6476074_01
case_images: Fibrinoid necrosis of the wall of interfascicular medium vessels with infiltration of inflammatory cells in muscle biopsy: (a) 10 x 10 and (b) 40 x 10.
case_images: CRIRH2019-4364289.001.jpg
case_images: PMC6476074_01_CRIRH2019-4364289.001.jpg
case_images: fig1
case_images: Calf muscle biopsy was performed, and histology showed fibrinoid necrosis of the wall of interfascicular small and medium vessels with infiltration of inflammatory cells (Figure 1).
case_images: Vasculitic rash over the legs (a), which later developed into the ecchymotic stage (b).
case_images: CRIRH2019-4364289.002.jpg
case_images: PMC6476074_01_CRIRH2019-4364289.002.jpg
case_images: fig2
case_images: On the day 14 after admission, a vasculitic-type generalized rash appeared over the extensor surfaces of the forearms and legs (Figure 2(a)). Despite high-dose steroids with pulse therapy over one week, the rash progressed to an ecchymotic stage (Figure 2(b)).
case_images: Bilateral foot drop (a) and left ulnar claw (b).
case_images: CRIRH2019-4364289.003.jpg
case_images: PMC6476074_01_CRIRH2019-4364289.003.jpg
case_images: fig3
case_images: Subsequently, we noticed that he developed bilateral foot drop, and after few days, he developed left ulnar claw (Figures 3(a) and 3(b)).
case_images: Stenosed segment of the celiac artery in CT angiogram (arrows).
case_images: CRIRH2019-4364289.004.jpg
case_images: PMC6476074_01_CRIRH2019-4364289.004.jpg
case_images: fig4
case_images: Hence, we performed a renal and mesenteric artery CT angiogram which revealed 8 mm stenosed segment of celiac artery 5 cm distal to its origin without evidence of visible aneurysms elsewhere (Figure 4).