i n d i a n j o u r n a l o f r h e uma t o l o g y 9 ( 2 0 1 4 ) S 7eS 6 7S8

and immune studies were negative. Chest x-ray showed right

hilar enlargement. Serum ACE levels and serum calcium were

normal. The biopsy from the purpura yielded a histological diag-

nosis of leukocytoclastic vasculitis and direct immunofluores-

cence (DIF) was negative. Computed tomography (CT) disclosed

significant mediastinal lymphadenopathy and matted lymph

nodes in the lesser sac. Montoux test was highly positive. In view

of high ESR, lymphadenopathy and positive montoux test, anti-

tubercular treatment (ATT) was started. After oneweek of starting

ATT, the skin lesions and fever completely resolved. CT chest and

abdomen repeated after 2 months showed significant regression

of lymphadenopathy. ATT continued for 6 months. Complete

resolution of the lymphadenopathy was noted on Magnetic

Resonance Imaging of chest and abdomen done 1 year later.

Conclusion: Although incidence is rare, tuberculosis should be

considered the possible underlying cause of vasculitis.

P4. Elderly lady with renal limited vasculitis presenting aspyrexia of unknown origin and progressive renal dysfunction

Betsy Ann Josepha, Vimal Abrahama, Anand Zachariaha,

Anna T. Valsonb, V. Kavitac; aDepartments of Medicine;bNephrology; cPathology, Christian Medical College, Vellore, India

Introduction: Pauci-immune ANCA vasculitis is when there is

absence of immunoglobulins as assessed by immunofluorescence

on renal biopsy. It can be renal- limited or can be renal manifes-

tation of systemic vasculitis such as Wegener's granulomatosis,

Churg-Strauss vasculitis or microscopic polyangiitis.

Methods: A descriptive case report of an elderly lady with pauci-

immune renal-limited ANCA positive vasculitis, presenting as

pyrexia of unknown origin to a tertiary care hospital in South

India

Results: A 72 year old lady presentedwith 6months history of high

grade fever and weight loss of 15 kilograms. Elsewhere she was

treated with antibiotics, including anti-tuberculous therapy and

oral steroids. Her blood pressure readings were noted to be high

since the last 3months. Clinically shewas noted to have pallor and

high blood pressure. Investigations revealed anemia, elevated

creatinine, andurine analysis showed proteinuriawith sediments.

Urine protein/urine creatinine ratio was 1.18. Complements were

normal, ANA (antinuclear antibody) was negative and p-ANCA

(Anti-neutrophil cytoplasmic antibodies) was 227 (normal:<2).-

Renal biopsy showed focal and segmental proliferative, necro-

tizing glomerulonephritis with concomitant extensive necrotizing

granulomatous interstitial and periglomerular infiltrates. She was

initiated on prednisolone at 1 mg/kg and oral cyclophosphamide.

She became afebrile and renal functions remained stable.

Conclusions: In the setting of progressive renal dysfunction and

new onset hypertension it is important to consider the diagnosis

of vasculitis in a patient with pyrexia of unknown origin. Elderly

age and deteriorating renal function is usually seen with ANCA

associated vasculitis and if untreated may result in end stage

renal failure and death.

P5. Takayasu's arteritis mimicking Burger's disease:diagnostic and management challenges

Danveer Bhadu, Meha Sharma, Nilesh Nolkha, Aarti Sharma,

Anupam Wakhlu; Department of Rheumatology, King George'sMedical College, Lucknow, India

Introduction: Takayasu's arteritis is a large vessels vasculitis

commonly involves the aorta with its branches and the pulmo-

nary arteries. It occurs predominantly in females <40years age,

with female to male ratio of 8:1. We hereby present a 50-years

male, smoker, with bilateral lower limb gangrene and absent left

brachial and radial pulse who on CT angiography had diffuse

stenotic involvement of branches of arch of aorta and infrarenal

abdominal aorta suggestive of Takayasu's Arteritis.

Conclusion: This report intends to highlight that Takayasu's

arteritis may rarely have a predominant lower limb involvement,

and may be confused with Buerger's disease, especially in males.

Clinical distinction of the diagnoses is important, for prediction of

long term outcomes and prognosis.

P6. Clinical correlation of cutaneous vasculitis with renalinvolvement in systemic lupus erythematosus

M.M. Kavithaa, S. Srirama, M. Saravanana, J. Euphrasia Lathab,

S. Rajeswaria; aDepartments of Rheumatology; bImmunology, MadrasMedical College, Chennai, India

Aim: To study the clinical correlation of cutaneous vasculitis, a

lupus nonspecific skin lesion with renal involvement in patients

with lupus.

Methods: 47 patients with cutaneousmanifestations in lupus who

presented to us in the past one year were included in the study. 40

patients with severe acute lupus specific skin lesions and seven

patients with cutaneous vasculitis (a single variable of tender,

erythematous lesions over the palms and soles) were taken as

study groups. Renal biopsy was done in all patients irrespective of

urine protein creatinine ratio.

Results: Renal involvement was observed in 21 (out of 40) patients

with lupus specific skin lesions and in all 7 patients with cuta-

neous vasculitis (class III -2, class IV -3, and class V-2), p value

derivedwas statistically significant (p value 0.01). All patients with

cutaneous vasculitis had low complements, mean C3 ¼42.31þ25.2mg/L (p ¼0.02), mean C4 ¼ 7.29þ5.88 mg/L (P ¼0.01)

which was statistically significant.

Conclusion: We observed that cutaneous vasculitis over palms

and soles had 100% renal involvement. Should vasculitis be

grouped under lupus specific skin lesion? Based on our observa-

tion, we propose that all patients with cutaneous vasculitis should

undergo renal biopsy irrespective of urine protein creatinine ratio,

though large scale studies are needed.

P7. Study of etiology and outcome of chronic lower extremityulcer

Amol Rauta, Rushabh Kotharia, Lalana Kalekara, Rachana Dhuratb,

Yojana Gokhalea; aRheumatology Services, Department of Medicine;bDepartment of Dermatology, Lokmanya Tilak Municipal MedicalCollege, Mumbai, India

Introduction: Ten percent leg ulcers have etiology other than dia-

betes, traumaorvenous insufficiencywhich isoftennot investigated

leading to prolonged illness and its socioeconomic consequences.

This study was conducted to find its etiology and outcome.

Methods: Serial recruitment of patients with non-diabetic, non-

traumatic chronic ulcer(>1 month) who were thoroughly inves-

tigated(CBC, Urine routine, Serum lipids,ESR,CRP,RA,AntiCCP,

ANA,ANCA,C3,C4,Cryoglobulins,LA,ACLA,Anti-beta2glycoprotein,

HIV, HBsAg, HCV, Doppler, Nerve conduction study and Biopsy of