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PAN's labyrinth: a multidisciplinary delayed diagnosis and patient's perspective.
Emma Louise Barlow1, Owen Seddon2, Brendan Healy2
1Cardiff University, Cardiff, UK Greater Manchester, UK.
BMJ Case Reports
|January 7, 2016
Summary
Polyarteritis nodosa (PAN), a rare vasculitis, can present with diverse symptoms leading to misdiagnosis. This case highlights a complex presentation and management, ultimately achieving full recovery.
Area of Science:
- Rheumatology
- Internal Medicine
- Pathology
Background:
- Polyarteritis nodosa (PAN) is a severe vasculitis affecting medium-sized arteries.
- Hepatitis B virus-associated PAN (HBV-PAN) incidence is decreasing due to vaccination and screening.
- PAN presents as a multisystem syndrome with varied clinical manifestations.
Observation:
- A patient presented with classical PAN features over several months, leading to consultations across multiple specialties.
- Isolated symptom management resulted in misdiagnoses, including testicular cancer, causing significant patient distress.
- Acute pancreatitis developed post-treatment, potentially iatrogenic or secondary to PAN.
Findings:
- The patient's presentation mimicked other conditions, complicating diagnosis and treatment.
- Delayed diagnosis and management contributed to prolonged illness and morbidity.
- Complete resolution of both PAN and pancreatitis was eventually achieved.
Implications:
- This case underscores the diagnostic challenges posed by the varied presentation of PAN.
- Highlights the importance of a holistic diagnostic approach for complex multisystem diseases.
- Demonstrates the possibility of favorable outcomes even in protracted and complicated cases of PAN.
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