A rash that yields no diagnosis!

After receiving an iron infusion, I developed a type of leukocytoclastic vasculitis, initially manifesting as a rash localised to the lower extremities of my legs. Over time, similar patches appeared on my back; although these were less severe, they were still noticeable. Despite undergoing several test, the results were inconsistent. I tested positive twice for P-ANCA and C-ANCA, with the second test showing elevated levels. However, a third test from a different laboratory came back negative. A CT scan did not reveal any vasculitis, and a nose tissue biopsy was inconclusive. My rheumatologist requested a kidney biopsy, but the physician refused due to the risks involved, suggesting that a diagnosis should be based on the positive ANCA tests. To manage the symptoms, I used cortisone, which alleviated some of the rashes. However, the condition persists intermittently, with new patches appearing on my ear and forehead. 

The absence of a confirmed diagnosis has been both frightening and painful, leaving a lasting impact. Since this ordeal began, I have never felt genuinely normal. The extreme fatigue accompanying these symptoms has further compounded the challenges, making daily activities and maintaining a sense of well-being difficult. Moreover, I have experienced blood in my urine numerous times, and the doctors have not provided any explanation for this. I also underwent a fat pad biopsy that indicated positivity for morphea. For those unfamiliar with the term, morphea is a rare skin condition characterised by hard, discoloured patches. Despite the biopsy results, I exhibit no clinical manifestations of morphea, such as skin patches. I have no clear diagnosis, and doctors cannot find any indication to give a positive vasculitis diagnosis. Although initially suspected to be EGPA, it is now undiagnosed.EGPA, or Eosinophilic granulomatosis with polyangiitis, is a rare condition involving blood vessel inflammation. This inflammation can cause damage to various organs and tissues in the body. 

The term "eosinophilic" refers to a type of white blood cell called eosinophils, which are often present in higher than normal amounts in people with EGPA. These cells are part of the immune system and help fight off infections and respond to allergies. In my case, tests have confirmed consistently high eosinophil levels, which align with the characteristics of EGPA.In addition to these challenges, I also suffer from chronic rhinitis and severe asthma. Rhinitis causes persistent inflammation of the nasal passages, leading to symptoms such as a runny nose, sneezing, and congestion. This condition can be particularly bothersome and exacerbate my overall discomfort. My asthma is severe, involving significant inflammation and narrowing of the airways. This results in frequent and intense episodes of wheezing, shortness of breath, chest tightness, and coughing. Managing my asthma requires constant vigilance and medication to prevent and control flare-ups, adding another layer of complexity to my health management.

The combination of leukocytoclastic vasculitis, unexplained symptoms like blood in my urine, morphea, rhinitis, and severe asthma has made my health journey incredibly complex and difficult to navigate. Each condition adds a layer of complexity, making daily life and overall well-being a constant struggle. The uncertainty surrounding my diagnosis and the ongoing symptoms have profoundly impacted my physical and emotional health.