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Abstract
Polyarteritis nodosa (PAN) has a broad spectrum of clinical presentation, since it affects small and medium-sized muscular arteries with microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction. Although skeletal muscle involvement is well documented in patients with PAN, it can mimic more common diseases, and cause confusion and delays in diagnosis. PAN muscular involvement may have limited or early systemic forms with a benign course and excellent clinical response to corticosteroid therapy. Herein, we describe the clinical course and outcome of four unusual cases of PAN manifested by acute onset of pain and pitting edema in both lower extremities; in addition, we reviewed the relevant literature.
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Figure 1.
(A) Erythematous swelling in the right lower leg and (B) computed tomographic scan showed intramuscular central low density and peripheral enhancement, and superficial fas-cial thickening with subcutaneous fat edema (arrows) and (C) whole body positron emission tomography scan showed markedly increased fluorodeoxyglucose uptakes in bilateral lower leg muscles.
Figure 2.
(A) Axial T2-weighted magnetic resonance imaging revealed diffuse edematous change and enhancement in the right thigh muscles (arrows) and (B, C) infiltration of vessel walls by neutrophils were seen histologically (H&E stain).
Figure 3.
(A) Erythematous macular rash on the left lower extremity and (B, C) axial T2-wei-ghted magnetic resonance imaging in the right lower leg showed multifocal ill-defined signal abnormality in the muscles and subcutaneous layers (arrows).
Figure 4.
Orbital computed tomographic scan revealed swelling and increased attenuation (arrow) of left periorbital soft tissue.
Table 1.
Summary of clinical presentations in our case series
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