Polyarteritis nodosa: a tale of two atypical presentations

Polyarteritis nodosa (PAN) is a rare necrotising vasculitis affecting small to medium-sized arteries, characterised by diverse clinical manifestations. This report describes two paediatric cases of PAN with unique presentations, diagnostic challenges and therapeutic responses. The first case involved recurrent lower motor neuron facial palsy, which is a rare manifestation of PAN (only a very few reported cases of isolated cranial nerve involvement), severe hypertension and cardiac involvement, while the second case presented with recurrent systemic inflammation, digital gangrene followed by autoamputation and peripheral vascular involvement. The diagnostic approach, including digital subtraction angiography and histopathology, along with tailored immunosuppressive management, is discussed. These cases highlight the importance of clinical suspicion, multisystemic involvement and early intervention in PAN.