{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:21:40Z","timestamp":1761110500632,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,11,10]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Systemic sclerosis (SSc) is characterised by non-inflammatory vasculopathy, autoimmunity and widespread fibrosis. While the presence of antineutrophil cytoplasmic antibodies (ANCAs) has been reported in SSc, their association with ANCA-associated vasculitis is exceedingly rare. Myeloperoxidase ANCA is more common than proteinase-3 ANCA, and glomerulonephritis is the most common clinical presentation of ANCA-associated vasculitis in SSc. ANCAs have been associated with the adverse disease outcomes in SSc, including higher mortality per recent reports. A 65-year-old man with diffuse cutaneous SSc for 6 years presented with new-onset peripheral neuropathy. Workup revealed a positive proteinase-3 and cytoplasmic ANCA, and histopathology confirmed an inflammatory vasculitic neuropathy. The patient was successfully treated with rituximab. Our case highlights the importance of checking ANCA in SSc at baseline, given the risk of disease-related complications, even years later. Tissue biopsy is often warranted for confirmation of vasculitis and prompt treatment can optimise long-term outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2019-232987","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T05:15:26Z","timestamp":1574831726000},"page":"e232987","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA)-associated vasculitic neuropathy in diffuse cutaneous systemic sclerosis: a rare duo"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1626-7741","authenticated-orcid":false,"given":"Yasser","family":"Radwan","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Berini","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Floranne","family":"Ernste","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8748-898X","authenticated-orcid":false,"given":"Ashima","family":"Makol","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,26]]},"reference":[{"key":"2025082723132470000_12.11.e232987.1","first-page":"918","article-title":"Autoantibodies to proteinase 3 and myeloperoxidase in systemic sclerosis","volume":"29","author":"Ruffatti","year":"2002","journal-title":"J Rheumatol"},{"key":"2025082723132470000_12.11.e232987.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1297-319X(02)00367-6"},{"key":"2025082723132470000_12.11.e232987.3","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e31827781fd"},{"key":"2025082723132470000_12.11.e232987.4","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1056\/NEJMoa1903076","article-title":"Nintedanib for systemic sclerosis-associated interstitial lung disease","volume":"380","author":"Distler","year":"2019","journal-title":"N Engl J Med"},{"key":"2025082723132470000_12.11.e232987.5","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.autrev.2016.07.016","article-title":"The clinical presentation and therapy of diseases related to anti-neutrophil cytoplasmic antibodies (ANCA)","volume":"15","author":"Weiner","year":"2016","journal-title":"Autoimmun Rev"},{"key":"2025082723132470000_12.11.e232987.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(12)80876-6"},{"key":"2025082723132470000_12.11.e232987.7","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jbspin.2003.04.002","article-title":"Anti-Neutrophil cytoplasmic antibodies in patients with rheumatoid arthritis: clinical, biological, and radiological correlations","volume":"71","author":"Tur","year":"2004","journal-title":"Joint Bone Spine"},{"key":"2025082723132470000_12.11.e232987.8","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket213"},{"key":"2025082723132470000_12.11.e232987.9","doi-asserted-by":"crossref","unstructured":"Moxey J , Huq M , Proudman S , et al . 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