Objective. To establish a set of clinical and paraclinical criteria potentially useful as a diagnostic screening tool for polyarteritis nodosa (PAN).Methods. The abilities of individual descriptive items to predict a diagnosis of PAN were evaluated by screening available data from 949 patients from the French Vasculitis Study Group database, including 262 with PAN and 687 with control vasculitides. Selected items were tested in a logistic regression model to establish a minimal set of nonredundant PANpredictive criteria. The discriminative accuracy of these items and of the American College of Rheumatology (ACR) 1990 criteria were assessed by reapplying them to the initial patient sample and a subgroup restricted to PAN and microscopic polyangiitis (MPA) patients. A computer simulation procedure was conducted on artificially generated patient data to evaluate the usefulness of these criteria in predicting a diagnosis of PAN.Results. The analysis resulted in the retention of The systemic vasculitides are a heterogeneous group of diseases that have blood vessel inflammation as a common trait. In 1990, relying on many previous efforts, the American College of Rheumatology (ACR) proposed a set of classification criteria that were selected by a panel of experts based on an analysis of multicenter patient data (1). Seven distinct entities were thus characterized, including polyarteritis nodosa (PAN) (2). Although the primary purpose of the ACR 1990 criteria was to standardize the classification of vasculitis patients to facilitate communication among researchers (3), their good discriminative accuracy indicated by the initial assessments, with sensitivities of 71-94% and specificities of 87-92% for different types of vasculitides,
Coexistence of IBD and AAV is a rare condition. The therapeutic management of these patients includes corticosteroids in all cases and immunosuppressive drugs in some patients. Coexistence of IBD and AAV might be explained by common underlying inflammatory responses and cytokine profiles polarized towards either Th1 or Th2. Finally, in the presence of digestive manifestations in the context of AAV, the hypothesis of IBD should be assessed.
A 39-year-old male from Maghreb, professional wrestler, with no family medical history, had been in perfect health until he developed muscular, back, and joints pain with fever and fatigue. The conjunctiva and the skin exhibited icterus; lumbar spine and knees were painful, and muscles were markedly tender. No other abnormalities were found during the examination. He had a regenerative anaemia (haemoglobin, 79 g/L; reticulocytes, 145 giga/L) with microcytosis (mean corpuscular volume, 72 fL), and mild thrombocytopenia (platelets, 110 3 109/L). The white blood cell count was 30,280/mm 3 with 21,500/ mm3 neutrophils and myelemia. The peripheral blood smear showed anisopoikilocytosis and target cells; schistocytes or sickle cells were absent. Total bilirubin was 56 Image 1. Whole body MRI using ''fluid sensitive'' STIR sequences (Short Tau Inversion Reconvery) without gadolinium showing diffuse hyperintense involvement of the bone marrow spine (a and c) (even spinous process, c) and pelvic lesions (sacrum, ilium, ischium) with sharp margins and serpentine borders in favor of bone infarcts. There is also vertebral body endplate collapse.
Asplenic patients are highly susceptible to infections with encapsulated bacteria such as Capnocytophaga canimorsus, a gram negative bacillus which is a commensal organism in cat and dog saliva. We describe the first case of septic shock due to C canimorsus infection occurring in a 51-year-old woman with functional asplenism related to systemic lupus erythematosus with antiphospholipid antibodies. Because of the potential severity of this infection, physicians have to be aware of its occurrence in lupus patients.
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