Cutaneous arteritis with compartment syndrome: Case report and review of published works

Abstract

Polyarteritis nodosa (PAN) refers to systemic necrotizing arteritis of small-to medium-sized muscular arteries. Cutaneous PAN is often referred to as Cutaneous arteritis (CA) since 2012, and CA is assumed to affect only the skin, but CA is occasionally associated with neuropathy and muscular disorders. [1][2][3] Here, we report a case of CA with muscle disorders accompanied by skin lesions on the limbs and muscular damage in the right lower limb, along with a review of the relevant literature. | C A S E REP ORTA 76-year-old Japanese man developed joint pain in all limbs and general fatigue about 1 month before his initial consultation to our department. On initial examination, the patient was lucid, his temperature was elevated to 37.9°C, his SpO 2 was 96% (room air), his blood pressure was 106/69 mmHg, and he showed tachycardia (heart rate 120 bpm).Blood analysis showed an elevated white blood cell count (26,100/μl; reference: 3900-9800), C-reactive protein (CRP) level (42.36 mg/dl; reference: 0-0.2), procalcitonin (PCT) level (50.910 ng/ml; reference: <0.5), and creatinine kinase (CK) level (4271 IU/L; reference: 45-226).The bilateral lower limbs exhibited redness, swelling, warmth, and purpura, which were significant on the right side. Furthermore, purpura with red halos was observed on the fingers, toes, and dorsum of the foot (Figure 1A,B). Contrast-enhanced computed tomography (CT) revealed no significant findings in the thoracoabdominal region but showed swelling of the right leg extensor muscle group, slight fluid retention between the superficial posterior and deep posterior compartments, and an elevated subcutaneous fatty tissue concentration (Figure 1C). However, no clear gas, abscess, intra-arterial thrombi or contrast enhancement of branching vessels were observed. Severe tension was observed in the right lower limb. The internal pressures of the right lower limb compartments were measured. The pressure of the anterior compartment was 40 mmHg and that of the superficial