The Diagnosis of Polyarteritis Nodosa in the Setting of Lower Extremity Lesions: A Case Report

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Authors

Eric Li, Corewell Health Resident
Jihan Toma, Corewell Health Resident
George Gopoian, Corewell Health

Description

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis affecting medium-sized arteries, involving multiple organs, with the most frequently affected tissues being skin and peripheral nerves (1). The distinct pearl neckless pattern led to the naming of this condition (2). Cutaneous polyarteritis nodosa (CPAN) is a variant of PAN confined to the skin, muscles and peripheral nerves in the absence of any systemic involvement (1). This rare form of systemic necrotizing vasculitis is limited to the medium-sized arteries of the skin and has a more favorable prognosis (1). PAN is also linked to Hepatitis B(2). The current diagnostic criteria for CPAN were proposed in 2009 by Nakamura et al.and include the presence of cutaneous manifestations and biopsy-proven fibrinoid necrotizing vasculitis of small and medium sized arteries (1). General non-specific symptoms such asthenia, fever, weight loss, myalgia, and arthralgia are frequently the symptoms of PAN (1). Neurological manifestation occur in more than 2/3 of patients, more commonly as motor and sensory mononeuritis multiplex of the peripheral nerves (1). Peripheral neuropathy is typically distal, asymmetric, and can be rapid-onset, often associated with localized skin edema (1). Skin lesions, including nodules, purpura, necrotic ulcers, and livedo reticularis, are present in half of the patients (1). In cases of cutaneous manifestations suggestive of vasculitis, a skin biopsy is recommended (1). The biopsy should be deep enough to include the dermal layer where medium-sized arteries are located (1). A subset of PAN, known as cutaneous PAN (CPAN) is confined to the skin and requires different management (1).

Publication Date

5-9-2024

Disciplines

Podiatry

Recommended Citation

Li E, Toma J, Gopoian G. The diagnosis of polyarteritis nodosa in the setting of lower extremity lesions: a case report. Presented at Corewell Health Hospital Farmington Hills 2024 Alvin Yarrows Research Day; 2024 May 9; Farmington Hills, MI.

Comments

2024 Alvin Yarrows Research Day at Corewell Health Hospital Farmington Hills, Farmington Hills, MI, May 9, 2024.