title: PAN's labyrinth: a multidisciplinary delayed diagnosis and patient's perspective.
abstract: Polyarteritis nodosa (PAN) is a rare, severe form of vasculitis affecting medium-sized vessels. It manifests as a multisystem syndrome, and may be associated with hepatitis B virus-associated PAN (HBV-PAN) although the incidence of this is declining with better vaccination strategies and awareness of bloodborne virus screening. We report a case in which a patient displayed many classical features of the disease, occurring separately over a period of months and leading to contact with various medical specialties. Managing each symptom in isolation led to a number of misdiagnoses (including testicular cancer) and the patient experienced considerable psychological stress and morbidity as a result. The case was complicated by acute pancreatitis developing after an initial treatment response. This may have been iatrogenic (as a consequence of either entecavir or steroids) or secondary to PAN. For our patient, this led to a protracted clinical course but eventual complete resolution of both pathologies.
authors.affiliation: Cardiff University, Cardiff, UK Greater Manchester, UK.
authors.forename: Emma Louise
authors.initials: EL
authors.lastname: Barlow
authors.affiliation: Department of Microbiology, University Hospital of Wales, Cardiff, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Seddon
authors.affiliation: Department of Microbiology, University Hospital of Wales, Cardiff, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: Healy
mesh_terms: D000792:Angiography; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010195:Pancreatitis / Q000209:etiology; D010488:Polyarteritis Nodosa / Q000175:diagnosis* / Q000821:virology; D013736:Testicular Neoplasms / Q000175:diagnosis