DIAGNOSES AND DISCUSSION OF CHALLENGING CLINICAL CASE NO. 04/2001
Polyarteritis nodosa
| Polyarteritis nodosa is a vasculitis of medium-sized vessels. Early systemic features include fever, weakness, anorexia, weight loss, myalgias and arthralgias (though severe and persistent arthritis is uncommon). Pericarditis and pleuritis also can occur. Mononeuritis multiplex develops because of involvement of the vasa nervorum; it is reflected in the man described by the sudden loss of the abilaity to dorsiflex his right great toe. Abdominal pain occurs in 60 to 70 percent of affected persons and is related to disease involvement of mesenteric arteries. Hyperrtension develops from arteriala occlusion and occurs before renal involvement. Laboratory findings of elevated erythrocyte sedimentation rate, anemia aof chronic disease, and polymorphonuclear leukocytosis all occur with polyarteritis bodosa. Pulmonary involvement is unusual and serves to distinguish this entity clinically from allergic granulomatosis and Wegener’s granulomatosis. Hypersensitivity vasculitis is a term applied to small-vessel vasculitides associated with a range of findings- from purely cutaneous disease to minimal skin disease but life-threatening involvement of major organs. Giant cell arteritis involves the aorta and other great vessels, producing constitutional symptoms and large-vessel occulusion in young women (Takayasu’s disease) and in the elderly (temporal arteritis, polymyalgia rheumatica). |