Rheumatoid Arthritis Rapidly Progressed to P-Anca Vasculitis Presented As Distal Limb Gangrene And Peripheral Neuropathy: A Less Recognised Overlap Syndrome

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis, is the most common primary systemic small-vessel vasculitis occurring in the adult population. Although the etiology is not well known always, the incidence of vasculitis is on increasing trend, with a variability in clinical expression. Renal and pulmonary manifestations are most common with all types of vasculitis. We are reporting a case of young male with un-specified small vessel vasculitis, presented initial as rheumatiod arthritis and later progressed very rapidly in the form of progressive vasculitic neuropathy and extensive limb gangrene and digital ischemia, with normal renal and pulmonary systems, which was diagnosed on the basis of clinical features and positive perinuclear anti neutrophil cytoplasmic antibodies (ANCA) P MPO done by Enzyme Linked Immunosorbent Assay (ELISA).