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Lee, Han, Kim, Lee, and Kang: A Case of Polyarteritis Nodosa Manifesting as a Neuropathy Following Influenza Infection
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(3): 163-167.

Published online: 30 June 2012

DOI: https://doi.org/10.4078/jrd.2012.19.3.163

A Case of Polyarteritis Nodosa Manifesting as a Neuropathy Following Influenza Infection

Dong-Hwa Lee1, Jung-Ho Han1, Mi-Kyoung Kim1, Ok-Jun Lee2, Kwi Young Kang1

1Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.

2Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.

Corresponding to: Kwi Young Kang, Department of Internal Medicine Chungbuk National University Hospital, Gaesin-dong, Cheongju 361-711, Korea. kykang@catholic.ac.kr

Received 30 June 2011       Revised 7 October 2011       Accepted 8 October 2011

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of the medium-sized arteries. The symptoms and signs of PAN include purpuric skin lesions, mononeuritis multiplex, symptoms of mesenteric ischemia, and renal involvement. We report the first case of PAN manifesting as a neuropathy after influenza infection in Korea. A 68-year-old woman had fever, myalgia, hyperesthesia of both hand and foot, and lower extremity weakness. EMG findings showed severe sensorimotor polyneuropathy, such as multiple mononeuritis. A sural nerve biopsy showed vasculitis and Influenza A (H1N1) were positive. Our patient was treated by glucocorticoid and oral cyclophosphamide, thereafter, symptoms and signs improved. No recurrence has been observed for five months.

Keywords: Polyarteritis nodosa, Influenza infection, Neuropathy

Figures and Tables

Figure 1
Chest images (A) Chest x-ray is normal without nodule or infiltration, (B) Chest CT shows normal lung and mediastinal structures.
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Figure 2
EMG findings showed positive sharp waves and fibrillations in the right abductor pollicis brevis. Electrophysiological findings are in accordance with severe sensorimotor polyneuropathy, such as mononeuritis multiplex.
jrd-19-163-g002
Figure 3
Pathologic findings. (A) Moderate mononuclear inflammatory cell infiltrates are noted in small sized epinurial vessels (H&E, ×200). (B) Some epineurial vessels shows wall thickening and infiltrated with mononuclear inflammatory cells (H&E, ×400).
jrd-19-163-g003

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