Case Report of International Journal of Case Reports
Cutaneous Polyarteritis Nodosa: A Rare but Severely Debilitating Disease
Alwyn Rapose1, John Najjar2
1Division of Infectious Diseases, Assistant Professor of Clinical Medicine, University of Massachusetts, Worcester, MA; 2Division of Vascular Surgery, Reliant Medical Group, Worcester, Massachusetts. USA 01608.
Cutaneous polyarteritis nodosa is a rare cause of ulcerations of the lower extremities. Inflammation and occlusion of small and medium sized cutaneous vessels results in painful nodules and skin ulcerations. Mild cases can be treated with topical corticosteroids or oral nonsteroidal anti-inflammatory medications. Severe cases require corticosteroids and other immunosuppressive therapies. A 47-year-old female patient presented to the infectious diseases outpatient clinic with multiple skin lesions of her lower extremities that failed to respond to courses of oral antibiotics. A deep tissue biopsy confirmed findings of vasculitis and she was initiated on corticosteroids. She developed progressive necrotic lesions as soon as corticosteroids were tapered. Angiography of the lower extremities revealed extensive abnormalities of bilateral tibial arteries and she was advised amputation. The patient sought a second opinion and underwent limb salvage therapy with surgical debridement, skin grafting and hyperbaric oxygen therapy along with systemic corticosteroids. She continues experiencing slow healing and has successfully avoided limb amputations. This case highlights the need to have a high index of suspicion of this rare but highly debilitating form of cutaneous vasculitis. Corticosteroids or other immune-modulating agents along with expert care at a specialized wound center can help patients avoid limb amputation.
Keywords: Cutaneous polyarteritis nodosa, Cellulitis, Tissue Necrosis, Surgical Debridement
How to cite this article:
Alwyn Rapose, John Najjar. Cutaneous Polyarteritis Nodosa: A Rare but Severely Debilitating Disease. International Journal of Case Reports, 2023, 7:283. DOI: 10.28933/iijcr-2022-11-2205ar
References:
1. Karadag O, Jayne DJ. Polyarteritis nodosa revisited: a review of historical approaches, subphenotypes and a research agenda. Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111[2]:135-142.
2. Lindberg K. Acta Med Scand 1931; 76: 183-225
3. Morgan AJ, Schwartz RA. Cutaneous polyarteritis nodosa: a comprehensive review. Int J Dermatol. 2010 Jul;49[7]:750-6.
4. Daoud MS, Hutton KP, Gibson LE. Cutaneous periarteritis nodosa: a clinicopathological study of 79 cases. Br J Dermatol. 1997 May;136 [5]:706-13.
5. Minkowitz G, Smoller BR, McNutt NS. Arch Dermatol 1991 Oct;127[10]:1520-3. Benign cutaneous polyarteritis nodosa. Relationship to systemic polyarteritis nodosa and to hepatitis B infection.
6. Radić M, Martinović Kaliterna D, Radić J. Drug-induced vasculitis: a clinical and pathological review. Neth J Med. 2012 Jan;70[1]:12-7.
7. Chen K R. J Dermatol. 1989 Dec;16[6]:429-42. Cutaneous polyarteritis nodosa: a clinical and histopathological study of 20 cases.
8. Bauzá A, España A, Idoate M.Cutaneous polyarteritis nodosa. Br J Dermatol. 2002 Apr; 146[4]:694-9.
9. De Virgilio A, Greco A, Magliulo G, et al. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016 Jun;15 [6]:564-70.
10. Hočevar A, Tomšič M, Perdan Pirkmajer K. Clinical Approach to Diagnosis and Therapy of Polyarteritis Nodosa. Curr Rheumatol Rep. 2021 Feb 10; 23[3]:14.
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