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Polyarteritis nodosa presenting as acute leg ischemia.
Emmanuel Héron1, Jean-Noël Fiessinger, Loïc Guillevin
1Service de Médecine Interne, C.H.N.O. des Quinze-Vingts, Paris, France. heron@quinze-vingts.fr
The Journal of Rheumatology
|June 5, 2003
Summary
Polyarteritis nodosa (PAN) can present unusually, causing acute leg ischemia due to arterial blockages. Early diagnosis via imaging, including limb ultrasonography, aids treatment with corticosteroids for recovery.
Area of Science:
- Vascular Medicine
- Rheumatology
- Diagnostic Imaging
Background:
- Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium-sized arteries.
- PAN can manifest with diverse clinical presentations, often involving multiple organ systems.
- Diagnosis typically relies on a combination of clinical, serological, and histopathological findings.
Observation:
- A 33-year-old hypertensive woman presented with acute leg ischemia secondary to infrapopliteal artery occlusion.
- Diagnostic imaging revealed widespread microaneurysmal and thrombotic lesions in the kidneys and extremities.
- A cutaneous biopsy confirmed necrotizing angiitis, consistent with vasculitis.
Findings:
- The case demonstrated an unusual presentation of PAN, characterized by acute limb ischemia as the primary symptom.
- Notably, the patient lacked constitutional symptoms despite extensive vascular involvement.
- Peripheral microaneurysms were effectively visualized using ultrasonography (US) of the limbs.
Implications:
- This case highlights the potential for PAN to present with atypical symptoms, emphasizing the need for a broad differential diagnosis.
- Ultrasonography of the limbs may serve as a valuable, non-invasive tool for detecting peripheral microaneurysms in suspected PAN cases.
- Prompt diagnosis and treatment with corticosteroids led to significant clinical improvement and functional recovery.