Polyarteritis nodosa presenting as peripheral vascular disease and acute limb ischemia

Abstract

Acute limb ischemia and peripheral vascular disease (PVD) are unusual presentations of polyarteritis nodosa (PAN). Here, we present a case with PVD of both lower limbs leading to foot claudication. Digital subtraction angiography showed narrowing, irregularity, and occlusion of both lower limb arteries with no involvement of the abdomen visceral arteries. Based on significant weight loss, diastolic blood pressure >90 mmHg, myalgia, testicular pain, and angiographic abnormalities in medium-sized arteries, he was diagnosed as having PAN. He was treated with corticosteroid and bolus intravenous cyclophosphamide following which he had prompt and near-complete recovery of the symptoms without any tissue loss.

A Case of Polyarteritis Nodosa Presenting as Rapidly Progressing Intermittent Claudication of Right Leg

“…In the two cases reported by Ninomiya et al [ 9 ] and Heron et al [ 10 ], there were demonstrable characteristic microaneurysms. But, Shukla and Aggarwal [ 13 ] and De Golovine et al [ 12 ] both described two cases with segmental stenosis of large vessels without aneurysmal dilatations, similar to our case. Our patient had unilateral predominant femoral involvement with unilateral renal artery stenosis.…”

“…Our patient presented with rapidly progressing predominantly unilateral intermittent claudication with asymmetrically absent pulses of lower limbs with high inflammatory markers and negative autoimmune markers such as ANA and ANCA. In one of the above cases, a patient has well responded to aggressive immunosupppression [ 13 ] and another patient has succumbed due to the side effects of the drug [ 12 ]. Our patient developed recurrent serious infections which made us discontinue his immunosuppression.…”

Polyarteritis nodosa: An unusual cause of life-threatening intra-abdominal bleeding

“…In addition to visceral bleeding, acute limb ischemia and necrotizing vasculitis have been reported in children. [4][5][6] The American College of Rheumatology (ACR) has established 10 criteria that can be useful for differentiating PAN from other diseases that cause vascular inflammation. [1] These include mycotic aneurysms, endocarditis with bacteremia embolization, giant cell arteritis or Wegener's vasculitis.…”

Polyarteritis Nodosa: Old Disease, New Etiologies

“…In terms of vascular manifestations, large vessels can be affected due to necrosis of the vasa vasorum [104]. Symptoms of arterial claudication can be indicative of stenosis or ischemia in the lower extremities [105][106][107].…”