Polyarteritis nodosa presenting as acute leg ischemia.
We describe a 33-year-old hypertensive woman with otherwise apparently good health, in whom acute leg ischemia by acute occlusion of the 3 infrapopliteal arteries led to the diagnosis of polyarteritis nodosa (PAN). Angiography and ultrasound imaging showed multiple microaneurysmal and thrombotic lesions, notably in the kidneys and the 4 extremities. Cutaneous biopsy showed necrotizing angiitis. She was treated with corticosteroids. Ischemia improved progressively, with normal walking after several months. Three points were remarkable in this case of PAN: (1) its unusual presentation; (2) the absence of constitutional symptoms despite the diffuse distribution of vascular lesions; (3) the good visualization of peripheral microaneurysms by ultrasonography (US), suggesting a potential diagnostic interest for US examination of the limbs in PAN.
Héron
Emmanuel
E
Service de Médecine Interne, C.H.N.O. des Quinze-Vingts, Paris, France. heron@quinze-vingts.fr
Fiessinger
Jean-Noël
JN
Guillevin
Loïc
L
D000208:Acute Disease; D000328:Adult; D000792:Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging*; D007866:Leg / Q000098:blood supply; D010488:Polyarteritis Nodosa / Q000000981:diagnostic imaging*; D012079:Renal Circulation; D014463:Ultrasonography