How do you approach an older male with a chronic and persistent granulomatous cutaneous medium vessel vasculitis that has been unresponsive/worsened on high dose steroids, cyclophosphamide, and rituximab immunosuppressive agents with a thorough and unremarkable serologic, infectious, and imaging work-up?

Answer from: at Community Practice

These types of patients vex all rheumatologists at one time or another during the course of clinical practice. The primary concern that is usually raised by a rheumatic disorder unresponsive to therapy is a paraneoplastic disorder. When you say you have a “thorough imaging work-up,” what...

Answer from: at Academic Institution

I'd consider a rebiopsy of the skin looking for an alternate diagnosis if unresponsive to two keystone medications of vasculitis treatment and steroids.

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at Brigham and Women's Hospital, Harvard University
Could he have VEXAS? Also a co fellow of mine rece...

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