Polyarteritis nodosa is a vasculitis that inflames medium-sized arteries, causing small aneurysms and blockages that starve organs of blood. It classically spares the lungs, can be linked to hepatitis B, and affects nerves, skin, kidneys and the gut.
Key symptoms
- Fever, weight loss, fatigue, muscle and joint aches
- Numbness or weakness in one hand or foot, such as foot drop
- Painful skin nodules, livedo reticularis or leg ulcers
- Abdominal pain after eating; testicular pain in men
What you find on exam
- Blood pressure, often new hypertension from kidney involvement
- Skin: livedo, tender nodules, ulcers, ischemic fingers or toes
- Nerve exam for mononeuritis multiplex
- Abdominal tenderness and peripheral pulses
Tests
- ESR and CRP raised, ANCA usually negative
- Hepatitis B and C serology
- Kidney function and urinalysis
- Biopsy of affected skin, nerve or muscle, or angiography showing microaneurysms
Treatment basics
- High-dose glucocorticoids such as prednisone
- Cyclophosphamide added for severe organ involvement
- Hepatitis B related disease: antiviral therapy with a short steroid course and plasma exchange
- Control blood pressure and monitor kidney function
Red flags
- Severe abdominal pain or bloody stool from bowel ischemia
- Rapidly spreading weakness or numbness
- Rising creatinine, very high blood pressure or chest pain
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.