Incidental Leukocytoclastic Vasculitis in the Context of IV Methamphetamine Use Following Syncope

Abstract

Dr. Malini Alexander (Dip-MSc Rheumatology) and Dr. Augustus Kigotho (FACEM)

BA Caucasian female in her early fifties presented to the authors’ emergency department for assessment following an unconscious collapse post IV methamphetamine use. On examination an incidental finding of a vasculitic rash on the patient’s legs resulted in investigations and a likely diagnosis of Primary Sjogren’s Syndrome. Punch biopsy revealed a leukocytoclastic vasculitis, which can be the presenting feature of pSS. Serology results that supported the diagnosis where exceptionally high RF titre extremely high RF titre (482 IU), ANA speckled pattern (1:2560), positive anti Ro/SSA and anti LA/SSB antibodies and hyperglobulinaemia. Notably the patient had a history of recurrent nephrolithiasis which is also commonly seen in association with pSS. This case demonstrates the importance of recognising rheumatic diseases that contribute to emergency department presentations as well as the usefulness of opportunistic biopsy and screening in such patients. Particularly in rural emergency department settings this can assist diagnosis and treatment in settings where rheumatology services are lacking.

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