Zahoor Sarmad, Siddique Samara, Mahboob Hafiz Mudabbar
King Edward Medical University, Mayo Hospital Lahore, Pakistan.
King Edward Medical University, Mayo Hospital Lahore, Pakistan.
Reumatol Clin (Engl Ed). 2020 Nov 4. doi: 10.1016/j.reuma.2020.08.008.
Polyarteritis nodosa (PAN) is a rare form of vasculitis which involves medium and small sized arteries. It can involve any system of the body, but lungs are typically spared. PAN typically presents with non-specific symptoms, such as fever, weight loss and myalgias, and symptoms related to the system involved. Negative serum ANCA helps in differentiating it from other similarly presenting vasculitis and definitive diagnosis is made on histopathology. Limb ischaemia is a rare presentation as well as a rare complication of PAN. We present the case of a 28-year-old female who presented with severe lower limb ischaemia and intermittent leg claudication as initial symptoms which led to initial diagnosis of critical limb ischaemia. Later in the course of the illness she developed gastrointestinal symptoms and weight loss. She was diagnosed as having PAN based on laboratory results and histopathological evidence. Intravenous steroids halted the progress of the disease, but the patient required transmetatarsal amputation of the foot to remove dead tissue. Vasculitis like PAN, although much rarer than atherosclerotic peripheral vascular disease (PVD), should be considered as a differential diagnosis in cases of limb ischaemia in which there is lack of risk factors for PVD.
结节性多动脉炎（PAN）是一种罕见的血管炎形式，累及中小动脉。它可累及身体的任何系统，但肺部通常不受影响。PAN通常表现为非特异性症状，如发热、体重减轻和肌痛，以及与受累系统相关的症状。血清ANCA阴性有助于将其与其他表现相似的血管炎相鉴别，确诊依靠组织病理学检查。肢体缺血是PAN罕见的表现及并发症。我们报告一例28岁女性，最初症状为严重下肢缺血和间歇性跛行，最初诊断为严重肢体缺血。在病程后期，她出现胃肠道症状和体重减轻。根据实验室检查结果和组织病理学证据，她被诊断为PAN。静脉注射类固醇药物阻止了疾病进展，但患者需要进行经跖骨截肢以清除坏死组织。像PAN这样的血管炎，虽然比动脉粥样硬化性外周血管疾病（PVD）罕见得多，但在缺乏PVD危险因素的肢体缺血病例中，应将其视为鉴别诊断之一。
