A Rare Case of Limited Muscle Involvement in Polyarteritis Nodosa

2021 ◽  
Vol 25 (1) ◽  
pp. 53
Author(s):  
Sung Oh Song ◽  
Ro Woon Lee ◽  
Mie Jin Lim ◽  
Seong Ryul Kwon ◽  
Won Park
Keyword(s):  
Polyarteritis Nodosa ◽  
Rare Case ◽  
Muscle Involvement

scholarly journals FRI0222 MAGNETIC RESONANCE IMAGING OF MUSCLE INVOLVEMENT IN POLYARTERITIS NODOSA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 694.2-694
Author(s):  
R. D. Vargas Ruíz ◽  
J. A. Gómez Rosero ◽  
C. Muñoz ◽  
D. Jaramillo Arroyave ◽  
L. Hernandez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Polyarteritis Nodosa ◽  
Medium Size ◽  
Cotton Wool ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Muscle Involvement ◽  
Nodular Pattern ◽  
Calf Pain

Background:muscle involvement is frequently reported in polyarteritis nodosa (PAN), mostly as myalgia, muscle swelling, and gait difficulty due to intramuscular arteries involvement, peripheral neuropathy, or myositis with slightly or no elevation of muscle enzymes. Magnetic resonance imaging (MRI) findings of compromised muscles have been reported in isolated cases, mainly as a limited form of PAN, however, muscular involvement patterns in MRI of patients with PAN have been recently describedObjectives:to describe MRI of legs findings in patients with PAN in a tertiary center from Medellin-Colombia.Methods:it was performed a retrospective cross-sectional descriptive study of 15 adult patients who were clinically assessed as having PAN and who had undergone MRI of legs between January 2011 and December 2019. Characteristics already informed in previous studies, affected structures (muscle, subcutaneous tissue, and bone) and pattern of hyperintensities were described as diffuse pattern (signal alterations affecting the entire area of the involved muscle), patched pattern (areas of hyperintensities alternating areas of normal muscle signal intensity), and fluffy nodular pattern or cotton-wool appearance (round hyperintense lesions with fluffy margins centered on blood vessels).Results:clinical characteristics:myalgia, especially calf pain, was the most frequent muscular complaint; other clinical manifestations were: constitutional symptoms (80%), arthralgias or arthritis (50%), mono/polyneuropathy (33%), subcutaneous nodules (33%), livedo reticularis (20%), lower limbs ulcers (13%), abdominal symptoms (13%), and purpura (7%).MRI findings:bilateral muscular edema was found in all patients (100%), fatty infiltration (20%), edema of the subcutaneous cellular tissue (20%), and muscular atrophy (13%) were also described. A diffuse pattern occurred in 46% (n=7) of patients (figure panel A), a patched pattern (figure panel B) in 46% (n=7), and a fluffy nodular pattern or cotton-wool appearance (figure panel C) in 6% (n=1). The most frequently affected muscular group was gastrocnemius and soleus (67%), followed by anterior tibialis (27%), plantar, long peroneus, first finger flexors, and long flexors only affected in 7%. Bone involvement was found in 53%, being the tibia the most affected, followed by the fibula and the calcaneus. MRI led to guide the site of muscle biopsy to prove histological medium-size vasculitis in half of the patients.Conclusion:in patients with PAN suspicion who have muscular complaints, especially calf pain, MRI arises as an important diagnostic tool, and also as a guide to muscular biopsy to prove vasculitis. The patterns associated with PAN are diffuse, patched or fluffy nodular hyperintensities in gastrocnemius and soleus with or without bone compromise.References:[1]Kang, Y. et al. Muscle involvement in polyarteritis nodosa: Report of eight cases with characteristic contrast enhancement pattern on MRI. Am. J. Roentgenol. 206, 378–384 (2016).[2]Hofman DM, Lems WF, Witkamp TD, Putte VD, Bijlsma JW. Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa. Clin Rheumatol 1992; 11:402–404.FigureDisclosure of Interests:None declared

scholarly journals Cutaneous Polyarteritis Nodosa Presenting Atypically with Severe Pharyngeal Ulceration

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Bayanne Olabi ◽  
Justin C. Mason ◽  
Ziad Farah
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Magnetic Resonance Angiography ◽  
Polyarteritis Nodosa ◽  
Rare Case ◽  
Significant Weight Loss ◽  
Histological Assessment ◽  
Cutaneous Polyarteritis Nodosa ◽  
Nodular Lesions ◽  
Appropriate Therapy

Polyarteritis nodosa (PAN) is a multisystem, necrotising vasculitis of small- and medium-sized arteries with a predilection for the visceral vessels. Cutaneous PAN is a rare variant with symptomatic vasculitis limited to the skin, typically presenting as nodular lesions on the extremities with a propensity to ulcerate. We describe a rare case of histologically confirmed cutaneous PAN presenting in a 55-year-old Ghanaian woman with severe oropharyngeal ulceration. This was associated with dysphagia and significant weight loss. Oesophagoduodenoscopy showed that the ulceration extended throughout the oropharynx. Systemic polyarteritis nodosa was ruled out with magnetic resonance angiography. Our patient was treated successfully with corticosteroids and methotrexate. This case suggests that cutaneous PAN should be considered in the differential diagnosis of patients with oropharyngeal ulceration and that histological assessment is pivotal in establishing the diagnosis early in order to instigate appropriate therapy.

scholarly journals A Rare Case Report of ST-Segment Elevation Myocardial Infarction and Recurrent Chest Pain in Polyarteritis Nodosa

Cureus ◽  
2021 ◽  
Author(s):  
Pradeep Kumar Devarakonda ◽  
Vishal R Dhulipala ◽  
Monika Karki ◽  
Samir Garyali ◽  
Sarath Reddy
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Polyarteritis Nodosa ◽  
Rare Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Rare Case Report

scholarly journals Cutaneous polyarteritis nodosa and tuberculosis in a child: a very rare case report

2021 ◽  
Author(s):  
Reinan Tavares Campos ◽  
Lucia Maria Mattei Arruda Campos ◽  
Clovis Arthur A Silva ◽  
Pedro Vale Bede ◽  
Maria Fernanda Badue Pereira ◽  
...  
Keyword(s):  
Case Report ◽  
Polyarteritis Nodosa ◽  
Rare Case ◽  
Cutaneous Polyarteritis Nodosa ◽  
Rare Case Report

scholarly journals A Giant Aneurysmal Benign Fibrous Histiocytoma with Muscle Involvement: A Rare Case Report

2021 ◽  
Vol 33 (3) ◽  
pp. 295
Author(s):  
Ji Hye Heo ◽  
Han Na Hyun ◽  
Seon Bok Lee ◽  
Hee Seong Yoon ◽  
Si Hyub Lee ◽  
...  
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Fibrous Histiocytoma ◽  
Benign Fibrous Histiocytoma ◽  
Muscle Involvement ◽  
Rare Case Report

scholarly journals AB0514 CALF PAIN, KEY POINT IN THE DIAGNOSIS OF POLYARTERITIS NODOSA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1554.2-1554
Author(s):  
J. S. Peinado Acevedo ◽  
M. Calle ◽  
A. Medina ◽  
D. Jaramillo Arroyave ◽  
A. Vanegas ◽  
...  
Keyword(s):  
Polyarteritis Nodosa ◽  
Systemic Vasculitis ◽  
Clinical Manifestations ◽  
Hbv Infection ◽  
Renal Infarction ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Muscle Involvement ◽  
Severity Scores ◽  
Calf Pain

Background:polyarteritis nodosa (PAN) is a primary systemic vasculitis that is becoming a rare disease in part by the decrease in hepatitis B virus (HBV) infection due to widespread vaccination. It is characterized by a full vast constellation of nonspecific clinical manifestations, which sometimes delays and makes it difficult to diagnose. Still, muscle involvement is a feature that could guide the clinician.Objectives:to describe the main clinical and laboratory characteristics of patients with PAN and to confirm the frequency of muscle involvement.Methods:retrospective cross-sectional descriptive study of 23 adult patients diagnosed with PAN between January 2011 and December 2018 in two high complexity hospitals in Medellin-Colombia.Results:twenty-three patients met ACR 1990 classification criteria for PAN, 52% were men with a median age of 51 (IR 36-60), 78.3% were newly diagnosed, and only two patients (8.7%) had HBV infection. General symptoms (found in 95% of the patients), cutaneous (82%), and articular (56%) were the most frequent manifestations. Among systemic symptoms, myalgia, especially calf pain, was the most common characteristic (78.3%), followed by weight loss (73.9%), fatigue (69.3%), and fever (59.3%). Laboratory findings and severity scores are shown in the table. Angiography was performed in 27.3% of patients, finding splanchnic (renal, hepatic and splenic) microaneurysms (17.4%), stenosis (13%), and renal infarction (4.3%). Fourteen patients (61%) had at least one positive biopsy documenting medium-sized artery vasculitis, mainly skin, muscle, nerve, or both; 9 (39%) had normal or inconclusive biopsy findings. All patients received high daily doses of prednisolone (50 ± 16 mg); 52.2% required cyclophosphamide, 30.4% azathioprine, 17.4% methotrexate, 8.7% rituximab, 4.3% dapsone and 4.3% plasmapheresis; acetylsalicylic acid was given to half of the patients and only one required antiviral therapy for HBV. With treatment, 87% improved; 22.7% had an infection, and 8.7% of patients died.Conclusion:myalgia was the main characteristics of our PAN patients, especially in calves, and its presence in patients with other general, skin or articular symptoms should raise the suspect of this vasculitis.References:[1]Karadag O, Jayne DJ. Polyarteritis nodosa revisited: a review of historical approaches, subphenotypes and a research agenda. Clin Exp Rheumatol. 2018;36 Suppl 111(2):135–142.[2]Pagnoux C, Seror R, Henegar C, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62(2):616–626.TableCharacteristicPAN patients (n=23)CRP (mean and SD in mg/dl)6.3 ± 8.51ESR (mean and SD in mm/h)84 ± 38CPK (median and IR in U/L) normal value < 18076 (66)FFS (mean)1BVAS (median and IR)17 (7)PAN: polyarteritis nodosa; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; CPK: creatine phosphokinase; FFS: five factor score; BVAS: Birmingham Vasculitis Activity Score; SD: standard desviation; IR (interquartile range)Disclosure of Interests:None declared

scholarly journals CYSTICERCOSIS OF THE PARASPINAL MUSCLES: A CASE REPORT AND REVIEW OF LITERATURE

2020 ◽  
pp. 1-3
Author(s):  
Nazim Mughal ◽  
Nikhat Naaz ◽  
Deepankar Mishra ◽  
Ajay Srivastava
Keyword(s):  
Rare Case ◽  
Clinical Presentation ◽  
Oral Treatment ◽  
Review Of Literature ◽  
Paraspinal Muscles ◽  
Public Health Importance ◽  
Muscle Involvement ◽  
Case Presentation ◽  
Body Tissues ◽  
Spinal Muscles

Introduction: Cysticercosis is a disease of public health importance which causes significant morbidity and mortality in developing countries including India. The clinical presentation of cysticercosis is variable and involves various body tissues. Isolated muscle involvement of cysticercosis is relatively rare. Case Presentation: We report a case of 28 year old female with complaints of mid back pain. Investigations revealed cysticercosis of the para-spinal muscles. Due to non-resolution of symptoms with oral medication, patient was managed surgically and the lesion was removed. Conclusion: Cysticercosis should always be included in differential diagnosis of muscle swelling in countries endemic for Taenia infection. Surgical resection may be required in muscular form of cysticercosis if significant improvement is not observed with conventional oral treatment.

scholarly journals Characteristic Imaging Patterns of Muscle Involvement in Polyarteritis Nodosa: Case Report and Review of the Literature

2021 ◽  
Vol 6 (2) ◽  
pp. 209-215
Author(s):  
Peikai Huang ◽  
Hailong Liu ◽  
Meng Zhang ◽  
Yanxia Chen ◽  
Jingzhi Ye ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Lower Leg ◽  
Lower Limbs ◽  
Muscle Involvement ◽  
Female Ratio ◽  
Study Results ◽  
The Right

Objective: Polyarteritis nodosa (PAN) is a rare disease with complex clinical manifestations that are difficult to diagnose. Imaging diagnoses of previously reported patients have focused on vascular manifestations. Magnetic resonance imaging (MRI) has been used to detect muscle involvement in PAN. Here, we reviewed imaging findings pertaining to muscle involvement in patients with PAN. Methods: Twelve articles concerning muscle involvement in PAN were published during the period 1980–2020; 21 patients, including our patient, were examined in this study. Results: Across the published articles, the male to female ratio was 1:1, the mean patient age was 40.76 ± 18.28 years, and there were 17 patients with calf involvement and 3 with thigh involvement. The T1WI and T2WI findings were both isointense in one patient, and the T1WI findings alone were isointense in seven patients. The T1WI findings were slightly hyperintense in five patients, and no T1WI images were available for the remaining seven patients. The T2WI signal was diffusely hyperintense in 10 patients, and “patchy villous hyperintense” in 9 patients. Among the 12 patients with enhanced images, most exhibited diffuse or cotton-like enhancement, while some showed involvement of the fascia and periosteum. The comprehensive imaging analysis of our patient included muscle and blood vessel MRI and computed tomography (CT) examinations. Our patient’s disease involved the calves and thighs, with T1WI isointensity and T2WI patch-like hyperintensity, as well as cotton-like enhancement centered on blood vessels. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) examinations of the lower limbs showed beadlike changes in the arterial branches, and the lower leg arterial branches were obvious. Head MRA revealed stenosis and occlusion of the right middle cerebral artery. Additionally, the superior mesenteric artery was locally dilated around a tumor, with the greatest width being approximately 9 mm. Cerebral perfusion analysis indicated cerebral blood flow (CBF) was lower in the right cerebellar hemisphere.Conclusions: PAN should be considered in the presence of patchiness or diffuse muscle signal changes on MRI of the lower leg (or thigh), followed by vessel-centered cotton-like enhancement accompanied by fascial or periosteal enhancement. Our findings suggest that systemic examination of small and medium arteries in patients with PAN can aid early prevention and treatment.

scholarly journals A rare case of polyarteritis nodosa associated with nontuberculous mycobacterial infection

2019 ◽  
Vol 7 (10) ◽  
pp. 1982-1983
Author(s):  
ShengYang Bertrand Lian ◽  
Yee Leng Teoh ◽  
Yong‐Kwang Tay
Keyword(s):  
Polyarteritis Nodosa ◽  
Rare Case ◽  
Mycobacterial Infection ◽  
Nontuberculous Mycobacterial Infection

Orbital Nerve Seath Myxoma with Extraocular Muscle Involvement: A Rare Case

2014 ◽  
Vol 30 (4) ◽  
pp. 316-320 ◽  
Author(s):  
Ignacio Rodríguez-Uña ◽  
Juan A. Troyano-Rivas ◽  
Cristina González-García ◽  
Reinaldo Chícharo-de-Freitas ◽  
Juan J. Ortiz-Zapata ◽  
...  
Keyword(s):  
Extraocular Muscle ◽  
Rare Case ◽  
Muscle Involvement
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