Fulminant polyarteritis nodosa associated with acute myeloid leukaemia resulted in bilateral lower leg amputation

Spectrum of Large- and Medium-Vessel Vasculitis in Adults: Neoplastic, Infectious, Drug-Induced, Autoinflammatory, and Primary Immunodeficiency Diseases

“…Rarely, MVV or LVV can be observed in AML and CML. Apart from constitutional symptoms and symptoms related to cytopenias, leukemia can manifest with bone pain like a polymyalgic syndrome; examining the blood count in detail in is essential [ 31 , 37 – 39 , 41 ].…”

Successful bilateral popliteal-plantar bypasses for polyarteritis nodosa induced ischemia

“…reported the case of a 42-year-old with acute myeloid leukemia who developed PAN with bilateral lower extremity gangrene with no attempt at revascularization before bilateral lower extremity amputation due to rapid progression of symptoms despite systemic therapy including high-dose corticosteroids, cyclophosphamide, and plasmapheresis . 6 There are two reports of patients presenting with symmetric digital gangrene of both upper and lower extremities due to PAN without revascularization attempt. 4,5 The case reported here similarly had quite symmetric disease of his lower extremities.…”

“…1 PAN characteristically affects people in their 40s to 60s with a male predominance 2 and involves visceral vessels, however there are case reports of peripheral vascular involvement. [3][4][5][6][7][8][9] Criteria for diagnosis of PAN include 3 or more of the following symptoms or signs: weight loss of 4kg or more since illness began; livedo reticularis; tesitular pain or tenderness; myalgias, weakness, or leg tenderness; mononeuropathy or polyneuropathy; diastolic blood pressure >90 mmHg; elevated blood urea nitrogen > 40mg/dL or creatinine >1.5 mg/dL; hepatitis B virus; arteriogram showing aneurysms or occlusions of visceral arteries; and biopsy of small or medium-sized artery containing neutrophils, granulocytes, or mononuclear leukocytes in the artery wall. 10 This case of PAN caused critical limb-threatening ischemia with digital gangrene and contralateral intermittent claudication, and was successfully treated with bilateral revascularization by popliteal-plantar bypass.…”