Does spontaneous remission occur in polyarteritis nodosa? .
BACKGROUND
Polyarteritis nodosa (PAN) is a systemic vasculitis involving mainly medium-sized arteries and, rarely, small-sized arteries. The diagnosis is principally based on clinical exams, biopsy of an affected organ, and/or arteriography of renal or mesenteric arteries. Once diagnosed, immunosuppressive agents, such as glucocorticoids and cyclophosphamide, are generally introduced as soon as possible. Whether spontaneous remission of PAN occurs is therefore largely unknown.


METHODS
We describe the case of a 51-year-old woman who presented with a 4-day-history of intense pain in her left flank, hypertension, fever, microscopic hematuria, and acute renal failure. Contrast-enhanced renal ultrasound strongly suggested bilateral renal infarction. Medical history and an extensive workup allowed to exclude systemic embolism, recreational drug abuse, cardiac arrhythmias, and thrombophilia. A possible diagnosis of PAN was considered; however, within 2 weeks of admission, spontaneous remission of her clinical and biological symptoms occurred without the use of any immunosuppressive treatment. Finally, 3 months later, renal arteriography confirmed the diagnosis of PAN. The patient remains free of symptoms 1 year after initial presentation.


CONCLUSIONS
This case illustrates the importance of considering PAN in the differential diagnosis of renal infarction with inflammatory syndrome and shows that spontaneous remission of renal PAN can occur. .
Simon
S
Beyaert
Menno
M
Pruijm
Salah Dine
SD
Qanadli
Peter
P
Vollenweider
Matthieu
M
Halfon
D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007238:Infarction / Q000175:diagnosis; D007668:Kidney / Q000098:blood supply; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D012075:Remission, Spontaneous
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide