2nd Rheumatology Department, Clinical Rehabilitation Hospital, 700661 Iasi, Romania.
Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania.
Medicina (Kaunas). 2023 Jun 16;59(6):1162. doi: 10.3390/medicina59061162.
Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. : We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. : The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. : Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. : The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.
经典结节性多动脉炎(PAN)是一种系统性血管炎,其特征为影响中、小肌性动脉的炎症和坏死性病变,最常发生在血管分叉处。这些病变导致微动脉瘤形成、破裂的动脉瘤出血、血栓形成,进而导致缺血或器官梗死。:我们报告了一例复杂的临床病例,患者为多器官受累的晚期结节性多动脉炎。:44 岁患者,居住于城市,因急性缺血现象和前臂及右手间隔综合征自行到急诊室就诊,需要在整形外科诊所进行手术减压。:患者表现出明显的炎症综合征,伴有严重的正细胞低色素缺铁性贫血、氮潴留综合征、高钾血症、肝综合征和免疫紊乱:无胞浆型抗中性粒细胞胞质抗体(cANCA)、核周型抗中性粒细胞胞质抗体(pANCA)、抗 Scl-70 抗体、抗核抗体(ANA)和抗双链 DNA 抗体,且血浆补体系统 C3 分数较低。右手皮肤活检的形态学表现与临床数据相符,支持 PAN 的诊断。:病毒型 PAN 似乎是一种独特的实体,需要早期积极的药物治疗。