Vasculitis may seem straightforward, especially when you have access to tissue to help verify the diagnosis. Establishing a diagnosis often requires input from multiple specialties, including rheumatologists, nephrologists, pathologists, and radiologists. Even then, it might be necessary to take a second or a third look at the evidence to come up with a plausible diagnosis and institute a therapeutic plan.
“When your patient isn’t responding to treatment, it’s important to reassess the clinical picture and sometimes even the presumptive diagnosis,” said Anisha Dua, MD, MPH, Assistant Professor of Rheumatology and Director of the Vasculitis Center at the University of Chicago. “It is tempting when we are dealing with a sick patient to try and piece together the diagnostic puzzle. But when doing that, we may run the risk of ignoring some clues that don’t quite fit.”
Dr. Dua and Pankti Reid, MD, MPH, University of Chicago Vasculitis Center Fellow, will present a case during the Clinicopathologic Conference on Monday from 7:30—8:30 am that will demonstrate some of the difficulties that can arise when you start off on the wrong diagnostic track in what can seem like a clear case of vasculitis. CPC: Under the Microscope: The Evolution of a Diagnosis will walk through a case that started with pulmonary and skin findings.
The dialogue of this case will include insights from Jonathan Chung, MD, Associate Professor of Radiology and Chief of Thoracic Surgery, and Aliya Husain, MD, Professor of Pathology, both from the University of Chicago. As the case unfolds, the four will discuss the value of collaboration with colleagues in pathology and radiology, and the importance of being ready to reexamine basic assumptions about the patient and the case.
“When a patient is only partially responding or not significantly improving with treatment, we might be tempted to simply consider an escalation in immunosuppression,” Dr. Reid said. “What we really need to do is to step back and reassess the lens we have used to frame the clinical scenario. We should revisit and reexamine the entire history, starting from the first presentation, and not skip anything along the way.”
The initial pulmonary and skin findings were, indeed, very important in the final diagnosis, Dr. Dua said. But clinical features alone were not enough to explain the patient’s disease course. It took the expertise of multiple specialists including radiology and pathology to re-evaluate the case and ultimately change the therapeutic plan.
“Being willing and ready to re-evaluate is one of the take-homes from this case,” Dr. Reid said. “It highlights how we should collaborate between departments in order to improve patient care and work together to solve the diagnostic puzzle.”