The “Viral” Form of Polyarteritis Nodosa (PAN)—A Distinct Entity: A Case Based Review
Author:
Pașa Victoria1, Popa Elena23ORCID, Poroch Mihaela23ORCID, Cosmescu Adriana23, Bacusca Agnes Iacinta23, Slanina Ana Maria23ORCID, Ceasovschih Alexandr24ORCID, Stoica Alexandra24ORCID, Petroaie Antoneta23ORCID, Ungureanu Monica23, Popa Andrei Emilian2, Avram Raluca Ioana2, Bologa Cristina24ORCID, Poroch Vladimir2ORCID, Coman Elena Adorata234
Affiliation:
1. 2nd Rheumatology Department, Clinical Rehabilitation Hospital, 700661 Iasi, Romania 2. Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania 3. Department of Family Medicine, Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania 4. 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
Abstract
Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.
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