Yagi Issei, Yagi Shusuke, Nakanishi Keisuke, Tezuka Kazuki, Matsuyama Kazuo, Aibara Yasushi, Ishida Takuya, Yoneda Hiroto, Yamamoto Masaki, Ise Takayuki, Yamaguchi Koji, Yamada Hirotsugu, Soeki Takeshi, Wakatsuki Tetsuzo, Kitagawa Tetsuya, Nishioka Yasuhiko, Sata Masataka
Department of Cardiovascular Medicine, Tokushima University Hospital, Japan.
Department of General Medicine, Tokushima University Hospital, Japan.
Intern Med. 2025 May 1;64(9):1355-1358. doi: 10.2169/internalmedicine.4149-24. Epub 2024 Oct 4.
A delayed diagnosis of polyarteritis nodosa may lead to critical limb-threatening ischemia (CLTI). A 74-year-old woman presented with left-foot pain and was treated with oral vasodilators and antiplatelet agents. However, the distal ischemia progressed to CLTI, including gangrene of the fingers and toes, and bilateral foot dropping appeared because of peroneal nerve paralysis. Angiography of the extremities revealed obstruction and stenosis of medium-sized arteries. Based on the progressive distal gangrene, mononeuropathy multiplex, and pathological findings of necrotic vasculitis, polyarteritis nodosa was diagnosed, and the patient's condition improved. A biopsy and neurological examination are essential for the appropriate diagnosis of PAN and immediate treatment.
结节性多动脉炎的延迟诊断可能导致严重肢体威胁性缺血（CLTI）。一名74岁女性因左脚疼痛就诊，接受了口服血管扩张剂和抗血小板药物治疗。然而，远端缺血进展为CLTI，包括手指和脚趾坏疽，并且由于腓总神经麻痹出现双侧足下垂。四肢血管造影显示中等大小动脉阻塞和狭窄。基于进行性远端坏疽、多发性单神经病以及坏死性血管炎的病理结果，诊断为结节性多动脉炎，患者病情得到改善。活检和神经学检查对于结节性多动脉炎的正确诊断和及时治疗至关重要。
