This 50-year-old patient presented with fever and bilateral leg myalgias. Laboratory studies showed elevated ESR (120) and normal CPK. On physical examination the patient was noted to have pain upon palpation from the posterior knee down to the calf muscles on both sides.
What is your pathologic diagnosis?
A. Trichinellosis
B. Vasculitis
C. Sarcoidosis
D. Polymyositis
This medium magnification image shows chronic inflammation surrounding and infiltrating the wall of a small muscular artery. The lumen of the artery appears to be obliterated.
This higher magnification image shows several microlumens (black arrows) within what was the original lumen. These represent recanalization of an occluded blood vessel. The elastic lamina (white arrows) is visible as an undulating somewhat refractile appearing line within the blood vessel wall. An elastin stain is better than modified Gomori Trichrome at highlighting the integrity of the elastic lamina to assess for vessel wall injury. Note the small intact appearing nerve twig at the bottom of the image.
Answer: Vasculitis
The morphologic alterations are consistent with the pathologic diagnosis of vasculitis (“vasculitic myopathy”).
Reference(s) / additional reading:
Marcus ViniciusPinto, Kenneth Warrington, Matthew Koster, ElieNaddaf. Myopathy: an underrecognized manifestation of vasculitis (2864). Neurology 2020, 94 (15 Supplement) 2864
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