musculoskeletal and connective tissue disorders
Polyarteritis Nodosa (PAN)
Symptoms and Signs of PAN
PAN mimics many disorders. The course may be acute and prolonged, subacute and fatal after several months, or insidious, chronic, and debilitating. Symptoms of PAN depend mainly on location and severity of the arteritis and extent of secondary ischemia. Only one organ or organ system may be affected. Patients typically present with fever, fatigue, night sweats, loss of appetite, weight loss, and generalized weakness. Myalgias with areas of focal ischemic myositis and arthralgias are common. Affected muscles are tender and may be weak. Arthritis may occur. Symptoms and signs vary, depending on the organ or organ system predominantly affected: Patients usually present with asymmetric peripheral neuropathy, such as Multiple Mononeuropathy (mononeuritis multiplex) with signs of motor and sensory involvement of the peroneal, median, or ulnar nerves. As additional nerve branches are affected, patients may appear to have a distal symmetric polyneuropathy. Central nervous system:Headache and seizures can result. In a few patients, ischemic stroke and cerebral hemorrhage occur, sometimes resulting from hypertension. Renal:If small- and medium-sized arteries in the kidneys are affected, patients may have hypertension, oliguria, uremia, and a nonspecific urinary sediment with hematuria, proteinuria, and no cellular casts. Hypertension may worsen rapidly. Rupture of renal arterial aneurysms can cause perirenal hematomas. In severe cases, multiple renal infarcts with lumbar pain and gross hematuria may occur. Renal ischemia and infarction can lead to renal failure. Gastrointestinal:Vasculitis of the liver or gallbladder causes right upper quadrant pain. Perforation of the gallbladder with acute abdomen may occur. Vasculitis of medium-sized mesenteric arteries causes abdominal pain, nausea, vomiting (with or without bloody diarrhea), malabsorption, intestinal perforation, and acute abdomen. Aneurysms may develop in hepatic or celiac arteries. Cardiac:Some patients have coronary artery disease, which is usually asymptomatic, but may cause angina. Heart failure may result from ischemic or hypertensive cardiomyopathy. Livedo reticularis, skin ulcers, tender erythematous nodules, bullous or vesicular eruptions, infarction and gangrene of fingers or toes, or a combination may occur. The nodules in PAN resemble Erythema Nodosum , but, unlike nodules in erythema nodosum, the nodules in PAN can ulcerate, and have necrotizing vasculitis that is visible on biopsy within the walls of medium-sized arteries, usually located in the deep dermis and subcutaneous fat. Genital:Orchitis with testicular pain and tenderness can occur. 