Diagnostic and therapeutic problems of polyarteritis nodosa.

Eleven patients with a diagnosis of polyarteritis nodosa were seen over an 8-year period in Cape Town, and evaluated as to clinical presentation, the most effective diagnostic approach, and the response to therapy. The major features of fever, abdominal pain, peripheral neuritis, myalgia/arthralgia, weight loss, proteinuria, positive urinary sediment and high white blood cell count should readily lead to the diagnosis which can be confirmed by multiple muscle biopsies. At the same time an ellipse of skin and subcutaneous fat can be taken. If the diagnosis is made early enough, an aggressive approach to therapy with steroid and immunosuppressive drugs can induce a response even in those patients who already have renal failure.     

Bilateral ureteral stricture from polyarteritis nodosa

A case of bilateral, asynchronous ureteral stricture from polyarteritis nodosa is described. Two cases of unilateral ureteral stricture from polyarteritis nodosa have been reported previously. Ureteral obstruction not associated with retroperitoneal fibrosis is rare with polyarteritis nodosa.     

Renal failure associated with polyarteritis nodosa

We reported 5 patients with renal failure associated with polyarteritis nodosa (PN). In all patients the renal dysfunction became apparent from 2 to 4 weeks after the onset of fever or neuromuscular symptoms with laboratory findings supporting marked inflammatory process and took the course of either acute or rapidly progressive renal failure. The clinical diagnoses on admission were variable; fever of unknown origin, peptic ulcer disease, polyneuritis multiplex, disseminated intravascular coagulation and Buerger's disease. Microscopic examination of the kidneys in 3 by renal biopsy and in 2 by autopsy revealed crescentic glomerulonephritis without immunoglobulin deposit, segmental necrotizing glomerulonephritis, marked inflammatory infiltrate around the glomeruli, granulomatous lesion, tubular necrosis and cortical necrosis other than necrotizing vasculitis. The outcomes were favorable with prednisolone monotherapy in two patients who had biopsy-proven diagnosis and treatment early in the course. Of all PN the prevalence of renal involvement is considered to be about 70%, the prognosis of which has been considered very poor. However it seems possible to alter fatal outcome of this disease by starting treatment with confident histological proof early in the disease process.     

Spontaneous perirenal hematoma: a complication of polyarteritis nodosa.

Polyarteritis nodosa is a rare cause of perirenal hematoma owing to rupture of 1 of the aneurysms. Eleven cases have been reported previously in the English literature, including 5 with a preoperative angiographic diagnosis. Our case, which was diagnosed angiographically before a successful conservative operation, is the first report of a patient who survived 3 years. The pathology is discussed.     

Polyarteritis nodosa and cutaneous polyarteritis nodosa

Cutaneous vasculitis can present with a variety of lesions and associated symptoms. It is important for the clinician to be able to recognize vasculitis lesions and know when to pursue further laboratory studies that will determine the extent of the disease process in a patient. This review compares and contrasts polyarteritis nodosa with its cutaneous counterpart. The diagnostic workup and management of these two entities as well as the overall approach to a patient with a possible vasculitic condition are emphasized.     

Urologic manifestations of polyarteritis nodosa.

Polyarteritis nodosa is an unusual condition that infrequently presents with signs and symptoms essentially confined to the urinary system. Such a case necessitating bilateral nephrectomy owing to hemorrhage is described. The pathologic findings, pathophysiology and etiology of the condition as well as treatment by renal transplatation are discussed.     

Hepatobiliary complications of polyarteritis nodosa.

Although polyarteritis nodosa (PAN) may result in thrombosis or aneurysm formation in any organ in the body, hepatobiliary complications are unusual. We reviewed seven cases that demonstrated the diagnostic difficulties and therapeutic options available in the management of hepatobiliary PAN. No consistent sign that indicated the severity of hepatobiliary PAN could be identified. In cases of thrombotic PAN, acalculus cholecystitis usually could be diagnosed preoperatively. Early tissue diagnosis and aggressive intervention are required for appropriate patient treatment. If the diagnosis is unclear, a preoperative muscle or skin biopsy specimen is often helpful in establishing a tissue diagnosis of PAN, even if no obvious pathologic condition is evident. Patients who undergo celiotomy for acalculus cholecystitis or peritoneal signs of an unclear origin should have tissue specimens (gallbladder wall, liver, or omentum) submitted for pathologic study. Angiography may be diagnostic preoperatively or when results of biopsies are equivocal. In addition, early angiography can define the extent of visceral involvement and permit control by embolization of hemorrhage secondary to aneurysm rupture. Awareness of the possibilities of thrombotic, ischemic, or bleeding complications from PAN allows more aggressive and rapid management of abdominal complaints, especially in patients who are receiving immunosuppressant therapy.     

Secondary hydronephrosis to polyarteritis nodosa.

A case of secondary hydronephrosis to lesions from polyarteritis nodosa localized in a short segment of the mid-portion of the ureter together with sclerolipomatosis, periureteritis and functional stenosis is presented. Polyarteritis nodosa is a necrotizing vasculitis affecting small and middle-sized arteries of all organs but more particularly the kidney, heart, gastrointestinal tract, testicles, liver and the striad muscles. Localization in the fatty tissue surrounding the ureter with a periureteritis is not frequent, only 1 case has been published in the literature (1).     

Isolated testicular polyarteritis nodosa

Isolated polyarteritis nodosa is a rare condition that may be triggered by local exposure to certain agents capable of provoking local immunostimulation without a systemic immune reaction. Isolated polyarteritis nodosa in the testes presents similar histologic characteristics as those of systemic inflammation, although infarcted areas in the testis are more common in generalized polyarteritis nodosa. Definitive diagnosis requires histologic study. We present the case of a 26-year-old patient with isolated testicular polyarteritis nodosa whose symptoms consisted predominantly of intense testicular pain and slight enlargement of both testes.     

Infantile polyarteritis nodosa. A case report.

The clinical and postmortem findings in a 4-month-old infant with polyarteritis nodosa are presented. The relationship of this condition to mucocutaneous lymph node syndrome (MLNS) is discussed, and the relevant literature is reviewed.