Polyarteritis nodosa presenting as polymyositis*
Section snippets
Case report
A 24-year-old healthy white man began having myalgias, fever, sore throat, and muscular weakness 1 month before admission to the hospital. He received a course of oral antibiotics but showed no improvement. Thereafter, his symptoms progressed to include night sweats, weight loss of 12 pounds, and inability to rise from a chair or walk.
The patient's initial temperature was 100.1°F, heart rate 120 beats/min, blood pressure 118/68 mm Hg, and respiratory rate 26/min. He had an erythematous
Discussion
PAN is the prototypical necrotizing vasculitis, which involves small and medium muscular arteries. Kussmaul and Maier (2) first described the classic form of PAN in 1866. The pathologic hallmark of PAN is segmental necrotizing vasculitis, which leads to vessel wall damage, microaneurysms, and eventual end organ ischemia or necrosis (3).
PAN is a rare disease affecting men and women of all ages and races. The estimated prevalence of PAN is approximately 6.3 per 100,000 population. Prevalence
References (45)
Polyarteritis
Rheum Dis Clin North Am
(1990)- et al.
Association between polyarteritis and Australia antigen
Lancet
(1970) - et al.
The role of immune complexes in the pathogenesis of necrotizing vasculitis
Clin Rheum Dis
(1980) - et al.
Periarteritis nodosa: A clinical and angiographic analysis of 17 cases
Semin Arthritis Rheum
(1979) - et al.
Diagnostic criteria for polyarteritis nodosa in childhood
J Ped
(1992) - et al.
A sartorial challenge
Lancet
(1999) - et al.
Muscle involvement in polyarteritis nodosa: A patient presenting clinically as polymyositis and review of the literature
J Rheumatol
(1994) - et al.
Ueber eine bischer nicht beschriebene eigenthumliche Arterienerkrankung die mit Morbus Brightii und rapid fortschreitender allgemeiner Muskellahmung einhergeht
Deutsche Arch Klin Med
(1866) Illustrated histopathologic classification criteria for selected vasculitic syndromes
Arthritis Rheum
(1990)- et al.
Systemic vasculitis in association with human immunodeficiency virus
Arthritis Rheum
(1989)
Polyarteritis nodosa, hairy cell leukemia and splenosis
Am J Med
Systemic and isolated vasculitis: A rational approach to classification and pathologic diagnosis
Pathol Annual
Immunohistochemical characterization of inflammatory cells and immunologic activation markers in muscle and nerve biopsy specimens from patients with systemic polyarteritis nodosa
Arthritis Rheum
Antineutrophil cytoplasmic antibodies, abnormal angiograms and pathologic findings in polyarteritis nodosa and Churg-Strauss syndrome: Indications for the classification of vasculitis of the polyarteritis nodosa group
Brit J Rheumatol
Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa
Acta Radiol
Long-term follow-up study of periarteritis nodosa
Am J Med
Systemic vasculitis in a district hospital 1972-1980: Clinical and laboratory features, classification and prognosis of 80 cases
Quot J Med
Clinical features, prognosis, and response to treatment in polyarteritis
Mayo Clin Proc
Prognostic factors in polyarteritis
J Rheumatol
A syndrome of childhood polyarteritis
J Ped
Polyarteritis nodosa in older children
Pediatrics
The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa
Arthritis Rheum
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2024, Journal of Drug Delivery Science and TechnologyInflammatory muscle involvement in systemic vasculitis: A systematic review
2022, Autoimmunity ReviewsCitation Excerpt :Among the other imaging procedure employed for the diagnosis of muscle involvement, positron emission tomography (PET), reported in 4 cases, was negative in 2 [26,32] and displayed FDG uptake in the other 2 [32], while scintigraphy showed high gallium uptake in iliopsoas muscle in the only patient who underwent this procedure [33]. Blood exams usually displayed an elevation of inflammatory markers, while creatine-kinase were usually within normal range, exceptions made for 5 patients [22,28,29,34,35] who suffered from proximal muscle involvement. Indeed, while almost all patients had an inflammatory localization to calves, usually bilateral, only a minority of them suffered from proximal upper [34] and/or lower limb myositis [18,22,24,26,29,32,34], sometimes restricted to the fascia [18,24,36].
Polyarteritis nodosa isolated to muscles-A case series with a review of the literature
2020, Seminars in Arthritis and RheumatismPolyarteritis nodosa: A contemporary overview
2016, Autoimmunity ReviewsCitation Excerpt :The progression from one end of the spectrum to the other is uncommon. Virtually, any organ might be affected; however, for reasons that are not understood, PAN does not affect the lungs [12,19,22–24]. The occlusion or rupture of inflamed arteries might produce tissue ischemia or hemorrhage in a variety of organs and systems.
Vasculitic neuropathy
2013, Handbook of Clinical NeurologyCitation Excerpt :Electromyography usually shows a neuropathic pattern (i.e., spontaneous muscle fiber activity such as fibrillations, positive sharp waves, complex repetitive discharge indicating denervation, as well as polyphasic motor unit potentials of long duration and/or high amplitude indicating reinnervation). A myopathic pattern (i.e., polyphasic motor unit potentials of short duration and low amplitude) may be observed in cases with muscle vasculitis or a disease (e.g., connective tissue disease, sarcoidosis, amyloidosis) that predisposes to inflammatory myopathy (Marcaud et al., 2002; Plumley et al., 2002; Collins et al., 2010a). A whole nerve biopsy, usually of the sural or superficial peroneal nerve, can be considered as the standard diagnostic tool for vasculitic neuropathy.
Myositis as the initial presentation of panarteritis nodosa
2019, Reumatologia Clinica
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Address reprint requests to Hugo E. Jasin, MD, Director, Division of Rheumatology and Clinical Immunology, University of Arkansas for Medical Sciences, Mail Slot 509, 4301 W. Markham, Little Rock, AR 72205. E-mail: [email protected]