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1.
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Comprehensive Review and Assessment for
Practicing
Family Physicians
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Issue: February 1, 2007
Case: Vasculitis
Taken from
Med-Challenger FM Career
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Question:
Polyarteritis nodosa (PAN) is histologically characterized by
medial fibrinoid necrosis of the small and medium sized arteries
in virtually any organ. All of the following signs and symptoms
are consistent with PAN EXCEPT:
- acute onset of fever, chills, arthralgias
and myalgias
- mononeuritis multiplex
- pneumonitis, alveolar infiltrates,
pulmonary hemorrhage and/or hemothorax
- pericarditis, myocarditis, or myocardial
infarction
- proteinuria, hematuria, hypertension, and
renal failure
- retinal vasculitis on funduscopic
examination
- painful violaceous plaques with ulceration
and livedo reticularis
- hepatitis with transaminitis; intestinal
and gallbladder inflammation
Answer:
C
Remediation:
Pulmonary involvement is unusual or rare (though bronchial
vessels may be involved) in classic PAN.
"Microscopic polyangiitis" is a similar disorder affecting the
small vessels. It may overlap with PAN, and commonly includes
glomerulonephritis and pulmonary capillaritis.
Mortality is high without treatment as patients are at risk for
intestinal perforation, renal failure, and heart failure. The
renal disease of classic PAN is predominantly due to arteritis
and subsequent ischemic renal failure, whereas microscopic
polyangiitis is commonly associated with glomerulonephritis.
Acute flares of PAN are treated with prednisone, 2 mg/kg/day (80
mg maximum) or IV methylprednisolone, possibly combined with
cyclophosphamide PO or IV for 3 days.
About the Image(s):
Image 1:
Polyarteritis Nodosa on the Arm with Livedo Reticularis
PAN is characterized by a small and medium vessel vasculitis in
the deep dermis. Resultant necrotic plaques, subcutaneous
nodules, and livedo reticularis can also be seen.
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