ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (50)
Polyarteritis nodosa in Adult
Print Captions OFF
Other Resources UpToDate PubMed

Polyarteritis nodosa in Adult

Print Images (50)
Contributors: Samantha R. Pop MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Polyarteritis nodosa (PAN) refers to a systemic necrotizing vasculitis of medium-sized and occasionally small arteries. The exact etiology is unknown, but it likely involves immune complex deposition, autoantibodies, inflammatory mediators, and adhesion molecules.

PAN most commonly involves the skin, peripheral nerves, kidneys, joints, and gastrointestinal tract. Any organ may be affected, although the lungs are typically spared. Constitutional symptoms may include malaise, fever, weakness, myalgias, arthralgias, and weight loss in combination with multiorgan symptoms of ischemia or infarction such as abdominal pain, cutaneous ulcers, livedo reticularis, testicular pain, mononeuropathy multiplex, and hypertension. Neurologic manifestations with asymmetric peripheral neuropathy can result in motor and sensory deficits and are the most common presenting organ manifestation. Renal involvement is common, manifested by hypertension and renal impairment, but red cell casts are notably absent; their presence should raise suspicion for an alternative diagnosis. Cardiac involvement presenting with myocardial infarction has been described. Other complications include stroke, gangrene, renal failure, bowel ischemia and perforation, gastrointestinal bleeding, retinal detachment, and death. Corticosteroids and immunosuppressive medications are the cornerstones of treatment.

PAN usually affects individuals in the fourth to sixth decades of life. It is slightly more common in men, and there is no apparent racial predilection. An isolated cutaneous form also exists (cutaneous polyarteritis nodosa [cPAN]), which is more common in children. PAN has been most commonly associated with infection with hepatitis B (30% of patients are positive for the B antigen). There are reports of associations with hepatitis C, human immunodeficiency virus (HIV), cytomegalovirus (CMV), parvovirus B19, human T-lymphotropic virus (HTLV), and streptococci. There appears to be an association with inflammatory bowel disease. Minocycline has rarely been reported to induce both systemic PAN and limited cPAN.

Codes

ICD10CM:
M30.0 – Polyarteritis nodosa

SNOMEDCT:
155441006 – Polyarteritis nodosa

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Reviewed: 02/08/2019
Last Updated: 03/01/2019
Copyright © 2019 VisualDx®. All rights reserved.
Polyarteritis nodosa in Adult
Captions OFF Print 50 Images Filter Images
View all Images (50)
(with subscription)
 Reset
Polyarteritis nodosa : Abdominal pain, Fever, LDH elevated, Malaise, Neuropathy peripheral, Palpable purpura, Proteinuria, Vision loss, Arthralgia, Myalgia, CRP elevated, ESR elevated, RBC decreased
Clinical image of Polyarteritis nodosa
Retiform, erythematous plaques with central brown patches on the knees.
Copyright © 2019 VisualDx®. All rights reserved.