- N Engl J Med 2022; 387:833-838
A 3-year-old boy presented with abdominal pain and vomiting. He had associated chills without fever, nonbloody and nonbilious emesis, constipation, reduced urinary output, and a decreased activity level.
- N Engl J Med 2022; 387:168-176
A 17-year-old girl was admitted because of prolonged fever and cough. She had an elevated creatinine level and a low hemoglobin level. A diagnostic test was performed.
- N Engl J Med 2022; 387:67-73
A previously healthy 18-year-old woman presented to a primary care provider with a 2-month history of headaches and midscapular pain. The midscapular pain was worse at night and lessened with exercise.
- N Engl J Med 2022; 386:2221-2221
A 68-year-old man presented with a 2-month history of eye pain, redness, and blurry vision. He also had a 1-year history of dry cough, sinusitis, and unintentional weight loss. CT of the chest revealed lung nodules.
- N Engl J Med 2022; 386:374-374
A 42-year-old man presented with red, painful eyes, facial-nerve palsy on the left side, a large oral ulcer, and petechiae. Tests for antibodies against perinuclear antineutrophil cytoplasmic antibody and proteinase 3 were positive. Skin biopsy revealed leukocytoclastic vasculitis with perivascular eosinophils. A diagnosis of eosinophilic granulomatosis with polyangiitis was made.
- N Engl J Med 2021; 385:2377-2377
A 74-year-old woman presented to the emergency department with tongue necrosis and sudden-onset monocular vision loss. Biopsy specimens of the temporal arteries confirmed giant-cell arteritis.
- N Engl J Med 2021; 385:1797-1802
A 75-year-old man with a history of an untreated hepatitis C virus infection presented with a 4-day history of a pruritic rash on his lower legs. He noted generalized malaise and an unintentional weight loss of 7 kg over the past 2 months. A video showing aortic vegetation is available...
- N Engl J Med 2021; 385:628-639
The ability to block specific cytokine pathways has revealed pathophysiological differences among autoimmune diseases (e.g., the efficacy of TNF inhibitors in arthritides and inflammatory bowel disorders and their inefficacy in giant-cell arteritis and multiple sclerosis), providing a framework for reclassification.
- N Engl J Med 2021; 384:2054-2063
A 37-year-old woman with a history of injection-drug use was admitted with 3 weeks of abdominal pain. CT angiography showed aneurysmal dilatation of the infrarenal abdominal aorta (aortic diameter, 3.9 cm). Management decisions were made.
- N Engl J Med 2021; 384:e52
A 34-year-old woman presented with rhinorrhea, bloody nasal crusting, and nasal deformity that had progressed over a period of 7 years. Physical examination revealed complete collapse of the nasal bridge and retraction of the tip of the nose, and a diagnosis of granulomatosis with polyangiitis was made.
- N Engl J Med 2021; 384:664-665
In recent decades, substantial advances in the treatment of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis have led to a decrease in disease-related morbidity and mortality. The regimen for inducing remission in patients with severe ANCA-associated vasculitis has evolved on the basis of data from randomized clinical trials and typically consists of...
- N Engl J Med 2021; 384:599-609
The C5a receptor inhibitor avacopan was superior to a tapering schedule of prednisone with respect to remission of ANCA-associated vasculitis at 52 weeks. There were fewer glucocorticoid-associated adverse events in the avacopan group than in the prednisone group, and serious infections did not differ substantially between the two groups.
- N Engl J Med 2021; 384:651-662
A 68-year-old man with a history of bladder cancer presented with delirium, renal insufficiency, unintentional weight loss, and leukopenia. Examination was notable for a subtle facial droop on the left side, bibasilar crackles in the lungs, and hepatosplenomegaly. A diagnosis was made.
- N Engl J Med 2021; 384:481-483
High-resolution MRI and histopathological study of the brains of patients who had died from Covid-19 showed punctate hyperintensities and punctate or linear hypointensities, which represented various forms of pauci-inflammatory microvasculopathy. No evidence of active viral infection was found.
- N Engl J Med 2020; 383:67-67
A 78-year-old man with end-stage renal disease and microscopic polyangiitis, for which he was taking glucocorticoids, presented with fever, taste abnormalities, and a painful ulceration of the tongue. Biopsy of the lesion confirmed a diagnosis of cytomegalovirus infection.
- N Engl J Med 2020; 382:1750-1758
A 37-year-old man presented with arthralgias, rash, calf pain, and redness in both eyes. The C-reactive protein level was elevated, and the erythrocyte sedimentation rate was prolonged. Examination of the urine sediment revealed dysmorphic red cells. A diagnostic test was performed.
- N Engl J Med 2020; 382:671-673
Plasma exchange has been a mainstay of induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis who have rapidly progressive glomerulonephritis or diffuse alveolar hemorrhage.1-3 Clinical data, in vitro data, and data from studies in animals have shown that ANCAs are pathogenic.4 Plasma exchange rapidly...
- N Engl J Med 2020; 382:622-631
Among patients with severe antineutrophil cytoplasmic antibody–associated vasculitis, plasma exchange did not reduce the incidence of death or end-stage kidney disease. A reduced-dose regimen of oral glucocorticoids was noninferior to a standard-dose regimen with respect to death or ESKD.
- N Engl J Med 2019; 381:2353-2363
A 20-year-old man with a history of electronic-cigarette use presented to the hospital because of a history of dyspnea, intermittent fever, joint stiffness, and nasal congestion. Chest imaging showed ground-glass nodular opacities that were most prominent in the lower lungs. A diagnostic procedure was performed.
- N Engl J Med 2018; 379:2557-2557
An 84-year-old main presented with discoloration and pain in the fingers and toes that had progressed over a 2-week period. Biopsy findings were consistent with a medium-vessel vasculitis.