Polyarteritis Nodosa: A Rare Form of Presentation

Abstract

Poly arteritis nodosa (PAN) is a necrotizing vasculitis of medium caliber arteries in which the involvement of small vessels is not typical.The most affected organs are skin, gastrointestinal tract and peripheral nerves. In our case report, PAN presented with pain, swelling and altered sensation of the left leg, mimicking deep vein thrombosis, soft tissue infection or even a compartment syndrome. We present this case to raise awareness to this rare but possible form of PAN presentation, that will need a distinct approach.

A Case of Polyarteritis Nodosa with Positive Anti-Phospholipid Antibodies Presenting with Multifocal Myositis

“…Any organ containing small or medium arteries can be involved in PAN [20]. According to the literature, the most commonly affected organs are the skin, gastrointestinal tract, kidneys, peripheral nerves, and muscles… [5] [9] [12]. Skeletal muscle manifestations are not uncommon in PAN, with a rate varying from 30-70% [20].…”

“…Musculoskeletal involvement in PAN may present in a limited form or a component of a systemic entity, including myalgia, arthralgia, polymyositis-like syndrome, asymmetric nondeforming polyarthritis, acute leg ischemia, or myopathy [11]. Among them, myalgia has been well documented in about 51% of PAN cases, while myositis is a rare form of scenario [12]. The high incidence of myalgia is in line with the common involvement of intramuscular arteries and the peripheral nervous system in PAN [7] [12].…”

“…Initial blood tests revealed a remarkable elevation in in ammatory markers, including erythrocyte sedimentation rate (ESR), 93 mm/1st hour and 101 mm/2nd hour (ref. [3][4][5][6][7][8][9][10][11][12][13]; white blood cells (WBC), 29,000 cells/µl (ref. [4][5][6][7][8][9][10]; neutrophil cells (NEU), 24,000 cells/µl (ref.…”

“…Musculoskeletal involvement in PAN may present in a limited form or a component of a systemic entity, including myalgia, arthralgia, polymyositis-like syndrome, asymmetric nondeforming polyarthritis, acute leg ischemia, or myopathy [11]. The pathophysiology of muscular manifestations in PAN might be ischemia due to compromised intramuscular arteries, neuropathy of the peripheral nervous system, or, more rarely, myositis [12] [13].…”