Miteva Maria, Norgauer Johannes, Ziemer Mirjana
Department of Dermatology and Allergology, Friedrich-Schiller-University of Jena, Jena, Germany.
Am J Clin Dermatol. 2007;8(3):175-8. doi: 10.2165/00128071-200708030-00004.
Protean clinical manifestations of polyarteritis nodosa are described. Hence, a sequential multidisciplinary diagnostic approach, including thorough dermatologic examination and histologic verification in particular, are warranted in patients suspected of having this condition. The lack of both pathognomonic visceral and/or cutaneous features and specific serologic tests for identifying polyarteritis nodosa explains why making the diagnosis is often delayed. Furthermore, in some patients making the diagnosis is hampered because symptoms are missing or only mildly expressed. We report on a 67-year-old man diagnosed with systemic polyarteritis nodosa whose primary complaints included diplopia, extraordinary muscular pain of the lower extremities, and impaired walking. Inconspicuous subcutaneous nodules developed subsequently. The patient was treated initially with a pulse therapy of prednisolone (1000 mg/day for 2 days), followed by prednisolone 100 mg/day, gradually reducing over weeks. Rapid improvement in clinical and laboratory status was noted. The key message from this case report is that symptoms such as severe muscular pain of the lower extremities and acute diplopia, although also common to other systemic vasculitides and systemic autoimmune diseases, should raise early suspicion of a developing polyarteritis nodosa.
本文描述了结节性多动脉炎的多种临床表现。因此，对于疑似患有此病的患者，需要采取多学科的序贯诊断方法，尤其要进行全面的皮肤科检查和组织学验证。缺乏结节性多动脉炎的特征性内脏和/或皮肤表现以及用于识别该病的特异性血清学检测，这解释了为何诊断往往会延迟。此外，在一些患者中，由于症状缺失或仅轻微表现，使得诊断受到阻碍。我们报告了一名67岁被诊断为系统性结节性多动脉炎的男性患者，其主要症状包括复视、下肢异常肌肉疼痛和行走障碍。随后出现了不明显的皮下结节。患者最初接受了泼尼松龙脉冲治疗（1000毫克/天，共2天），随后为泼尼松龙100毫克/天，并在数周内逐渐减量。临床和实验室指标迅速改善。该病例报告的关键信息是，下肢严重肌肉疼痛和急性复视等症状，尽管在其他系统性血管炎和系统性自身免疫性疾病中也常见，但应尽早怀疑结节性多动脉炎的发生。
