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Introduction Systemic sclerosis (SSc) is a heterogenous autoimmune disorder affecting multiorgan systems.Presence of ANCA antibodies (pANCA against MPO antigen) or cANCA (against PR3 antigen) can be seen in SSc though ANCA vasculitis (AAV) occur tends to occur in only 2.9-9%.We illustrate two such cases.Material and Methods Case1: A lady in late fifty with stable diffuse SSc (Scl-70 positive) with raynauds and NSIP-ILD presented with subacute onset numbness left 4th and 5th toes which increased to involve dorsum and lateral aspect of ankle with reduced vibration and left ankle jerk. Plantar reflexes were downgoing. Subsequently in next few days developed pins and needle sensation in both 4th and 5th fingers spreading over the palms. A day later then developed numbness in hands and weakness in finger extension. Her salient investigation results are as in table 1.Case 2: A 73-yr lady with dcSSc with raynauds, telangiectasias, upper GI, arthralgia symptoms and NSIP-ILD with relatively normal ECHO [2024] presented to Emergency unit (October 2024) with fevers, night sweats, weight loss and was treated initially as ‘pneumonia’ with antibiotics.Thereafter she developed painful hands and feet numbness along with widespread vasculitic rash both legs and buttocks and increased breathlessness (no angina). Her salient investigations are as in table 2.Results Case-1 with AAV with renal and peripheral nerve involvement was treated with cyclophosphamide (CTX) intravenously and tapering doses of prednisone from 40mg. This was followed by azathioprine as maintenance therapy. She continues to improve towards premorbid time from neuropathy.Our case-2 with pANCA associated skin, peripheral nerves and cardiac involvement was treated with CTX (CYCLOPS Regime) along with prednisone 40 mg.Both cases were closely monitored for their BP and renal function. However, case-2 had partial response and continued to have paraesthesias in ankles and feet, so was swapped to Rituximab and her levels of pANCA improved from 187.7 to 64.3, Troponin I from 1623 to 29 and CRP from 158 to 2.9mg/L.Conclusions AAV can occur in SSc [AAV-SSc], more likely in dcSSc. It commonly presents with renal (RPGN) or crescentic GN or pulmonary manifestations or with myocarditis. However, mononeuritis multiplex or polyneuropathy has been rarely noted. Importantly HT, MAHA, thrombocytopaenia are commonly seen in SRC rather than AAV-SSc.Our two cases illustrate the need for awareness of AAV in SSc patients even if patients appear to be stable from SSc point of view.Abstract P.360 Figure 1–2Abstract P.360 Table 1–2