J Rheum Dis.  2012 Jun;19(3):163-167. 10.4078/jrd.2012.19.3.163.

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

• Lee DH
• Han JH
• Kim MK
• Lee OJ
• Kang KY

• KMID: 2223100
• DOI: http://doi.org/10.4078/jrd.2012.19.3.163

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.

Keyword

Polyarteritis nodosa; Influenza infection; Neuropathy

MeSH Terms

Aged
Arteries
Biopsy
Cyclophosphamide
Female
Fever
Foot
Hand
Humans
Hyperesthesia
Influenza, Human
Ischemia
Korea
Lower Extremity
Mononeuropathies
Organic Chemicals
Polyarteritis Nodosa
Polyneuropathies
Recurrence
Skin
Sural Nerve
Vasculitis
Cyclophosphamide
Organic Chemicals

Figure

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  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.

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  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).

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