J Korean Rheum Assoc.  2009 Sep;16(3):232-237.

A Case of Avascular Necrosis of Bone as the Initial Manifestation of Polyarteritis Nodosa

• Kim SM
• Park BH
• Kang YJ
• Park MH
• Song JK

Abstract

We describe a 28-year old man in otherwise apparently good health, in whom pain in his left knee joint caused by avascular necrosis led to a diagnosis of polyarteritis nodosa (PAN). The angiogram showed multiple microaneurysmal and thrombotic lesions, notably in the renal, mesenteric and tibial arteries. A skin biopsy of the upper dermis of the left thigh with an erythematous skin rash showed the infiltration of mononuclear leukocytes in the perivascular area. During hospitalization, he was diagnosed with chronic hepatitis B, and was treated with lamivudine, and corticosteroid, azathioprine to control the PAN. The knee joint pain improved progressively, and the patient could walk normally after several months. This case is an unusual presentation because the initial manifestation of PAN was avascular necrosis.

Keyword

Polyarteritis nodosa; Avascular necrosis

MeSH Terms

Azathioprine
Biopsy
Dermis
Exanthema
Hepatitis B, Chronic
Hospitalization
Humans
Knee Joint
Lamivudine
Leukocytes, Mononuclear
Necrosis
Osteonecrosis
Polyarteritis Nodosa
Skin
Thigh
Tibial Arteries
Azathioprine
Lamivudine

Figure

• 

  Fig. 1. Whole body bone scan showing increased uptake lesion in the left and right upper tibia, indicating osteonecrotic changes.

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  Fig. 2. Magnetic resonance imaging of the left knee. The coronal view of the proton image shows an irregular articular margin with bone cortical necrotic changes and diffuse low signal intensity in the upper tibia.

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  Fig. 3. Angiography. Renal angiography showing a multiple microaneurysm in the renal artery branches (A). Mesenteric angiography showing a multiple microaneurysm in the mesenteric vessels, mainly jejunal loop (B).

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  Fig. 4. Skin biopsy. Infiltration of many inflammatory cells at the perivascular area of the upper dermis (H&E stain ×100).

Reference

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