Cheng Wei, Yin Wei, Liu Fan, Yin Wen
Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Rheumatology and Immunology, Wuhan Children's Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Pediatr. 2025 Mar 13;13:1553118. doi: 10.3389/fped.2025.1553118. eCollection 2025.
Polyarteritis nodosa is a rare systemic necrotizing vasculitis that is often overlooked and misdiagnosed in clinical practice. Patients may exhibit fever, rash, myalgia, and further symptoms; in severe instances, this may result in damage to the kidney, heart, and other important organs, and may even be life-threatening. Consequently, prompt diagnosis and intervention might mitigate the occurrence of complications and improve patient prognosis.
An 11-year-old girl was admitted to our hospital with multi-joint pain for 7 days, accompanied by worsening fever for 4 days. The physical examination on admission revealed alterations in the skin texture characterized by scaling, a bluish-purple rash, and sensitive subcutaneous nodules on the extremities with limited mobility. Following admission, laboratory testing revealed high serum inflammatory markers, and positive anti-chain "O," rheumatic fever was initially considered. The symptoms were not relieved after the use of antibiotics and aspirin. After reviewing the literature, polyarteritis nodosa was highly suspected, and a skin biopsy indicated necrotizing vasculitis, therefore confirming polyarteritis nodosa. The child's symptoms were alleviated with the use of glucocorticoids in conjunction with immunosuppressive medication.
This case involves a child diagnosed with nodular polyarteritis subsequent to a streptococcal infection. For patients with a strong suspicion of polyarteritis nodosa, a timely skin biopsy or arterial angiography should be conducted to confirm the diagnosis and increase survival rates.
结节性多动脉炎是一种罕见的系统性坏死性血管炎，在临床实践中常被忽视和误诊。患者可能出现发热、皮疹、肌痛等症状；严重时，可导致肾脏、心脏等重要器官受损，甚至危及生命。因此，及时诊断和干预可减少并发症的发生，改善患者预后。
一名11岁女孩因多关节疼痛7天、发热加重4天入院。入院体格检查发现皮肤纹理改变，表现为脱屑、紫蓝色皮疹，四肢皮下结节敏感，活动受限。入院后实验室检查显示血清炎症标志物升高，抗链球菌溶血素“O”阳性，最初考虑为风湿热。使用抗生素和阿司匹林后症状未缓解。查阅文献后，高度怀疑为结节性多动脉炎，皮肤活检提示坏死性血管炎，从而确诊为结节性多动脉炎。使用糖皮质激素联合免疫抑制药物后患儿症状缓解。
本病例为一名链球菌感染后诊断为结节性多动脉炎的儿童。对于高度怀疑结节性多动脉炎的患者，应及时进行皮肤活检或动脉血管造影以明确诊断，提高生存率。
