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The authors describe a patient with periarteritis nodosa in whom rupture of an aneurysm associated with the disease led to perirenal hematoma. As a result, right nephrectomy was performed. Seven years later hepatic hemorrhage occurred and resolved spontaneously. These complications of periarteritis nodosa are rare, and their combination in the same patient is rarer still.
Infantile periarteritis nodosa is a rare disease characterized by systemic obstructive arteritis involving coronary artery. This report is anesthetic experience of a 12-years-old boy with unstable angina secondary to infantile periarteritis nodosa, who underwent left ventricular aneurysmectomy and coronary artery bypass grafting. Anesthesia was induced with fentanyl, diazepam and enflurane, and transesophageal echocardiography (TEE) was used as a cardiac function monitor. The following two intraoperative crises occurred in succession: first, aggravation of myocardial ischemia followed by ventricular tachycardia, and second, sudden interruption of cardiopulmonary bypass due to blood coagulation in membrane oxygenator. In these situations, we could detect his critical situations promptly, because segmental wall-motion abnormality and global enlargement of both ventricles were observed with TEE before the onset of these crises. In these crises, we could treat him appropriately. Postoperative course was uneventful and he had no neurological deficit nor angina. We conclude that TEE is a powerful non-invasive monitor for early detection of cardiac dysfunction in heart surgery.
Segmental retinal periarteritis is a relatively rare clinical entity with varied etiologies. This report describes a case of acute toxoplasmosis with segmental periarteritis without concomitant periphlebitis. To my knowledge this has never been reported previously. The diagnosis of toxoplasmosis was proven by both clinical findings and serology.
In a patient with cold-induced cutaneous periarteritis nodosa, cryoprecipitation of a circulating hepatitis B surface antigen-containing immunocomplex resulted in phagocytosis by neutrophils and monocytes with prominent vacuolation of the cells and extracellular release of lysosomal enzymes. We believe this immunocomplex attached itself to the cell membrane and induced vacuolation and degranulation in normal neutrophils.
Periarteritis nodosa is a disease with protean manifestations, yet there are few reports of ocular involvement. We treated a patient who was seen with conjunctival and anterior uveal involvement. The clinical histopathologic and immunopathologic characteristics are described. Immunopathologic studies are a useful adjunct in confirming the nature of this disorder.
The ocular pathologic findings were determined in a case of fatal infantile periarteritis nodosa (IPN). To our knowledge, this case is the first histologically documented report of choroidal inflammation associated with this disease. Since the clinical and pathologic findings of IPN and Kawasaki's disease (KD) are identical, these findings should be sought in cases of KD.
We describe a child who developed chronic cutaneous periarteritis nodosa at 5 years of age and whom we have observed over a five-year period. Although intermittent oral corticosteroids have been required to control symptoms, she has not demonstrated involvement of any organ other than the skin.
BACKGROUND: Modern magnetic resonance imaging (MRI) diagnosis of Tolosa-Hunt syndrome rests upon demonstration of cavernous sinus abnormalities. We present a case of Tolosa-Hunt syndrome who has no abnormal mass lesion in the cavernous sinuses on MRI but with a diagnostic lesion on magnetic resonance angiography (MRA). CLINICAL PRESENTATION: A 48-year-old woman developed acute periorbital pain and abducens palsy of the right side at the first episode, and subacute peri-orbital pain and rapidly deteriorating visual acuity on the left side at the second episode with a four months interval. MRI showed no soft-tissue abnormality in the cavernous sinuses. FINDINGS: MRA demonstrated a narrowing of the right cavernous carotid artery at the first episode, and narrowings of the left clinoid carotid and ophthalmic arteries at the second episode. Based on these findings, the patient underwent urgent steroid therapy and the symptoms resolved dramatically in each episode. Follow-up MRA confirmed resolution of arterial narrowings. INTERPRETATION: MRA may help prompt the noninvasive diagnosis in certain cases of Tolosa-Hunt syndrome with little inflammatory reaction in the cavernous sinus but with predominant intra- and juxta-cavernous periarteritis.
A case of sudden unexpected death in a 23 year old woman in her 8th month of pregnancy is reported. Death occurred from isolated coronary periarteritis with thrombosis. It is believed that the thrombosis was secondary to the adventitial infiltrate, which was of a type suggesting a hypersensitivity factor. It is proposed that pathogenetically this case is identical to reported cases of dissecting hemorrhage or aneurysm of the coronary artery and represents an entity different from other forms of inflammatory coronary disease.
Primary periarteritis, an uncommon necrotizing vasculitis in the dog, was found to affect, almost exclusively, the major branches of the coronary arteries in a number of young beagle dogs. The arteritis was mainly distributed in the proximal segment of the right coronary artery. Immunocytochemical studies failed to identify immunoglobulin deposits in the lesions and the cause of the arteritis remains unknown. It is important to be aware of this spontaneous condition and its regional distribution since certain cardiovascular drugs may also produce necrotizing arteritis at similar sites.
A 35-year-old woman displayed unusual symptoms of progressive bulbar dysfunction. At necropsy, systemic necrotizing vasculitis and small pontine infarcts were demonstrated. The angiographic and magnetic resonance imaging findings are described. The latter investigation is a sensitive method for detecting such pontine lesions. To our knowledge, this case is the first report of magnetic resonance imaging findings of brain stem infarct in a patient with periarteritis nodosa.
INTRODUCTION: Polyarteritis nodosa is a disease process with a wide clinical spectrum, ranging from a severe generalized multisystem disorder to a more benign condition which may remain limited to the skin, muscles and peripheral nerves, and is termed cutaneous polyarteritis nodosa. Periosteal bone formation is uncommon in this condition. EXEGESIS: We report two cases (two female patients of 80 and 55 years of age, respectively) who complained of red, tender nodules of legs and bone pain. Histological changes were those of necrotizing arteritis of the small and medium arteries in the panniculus and dermis. Bone X-ray showed periosteal bone formation. CONCLUSION: In patients with pain, skin changes and swelling of the lower limbs, the diagnosis of periarteritis nodosa with periostitis has to be considered.
The human immunodeficiency virus (HIV) may be responsible for several types of vasculitis: leucocytoclastic vasculitis, granulomatous angiitis, angiitis associated with lymphoproliferative syndromes or necrotizing vasculitis including periarteritis nodosa (PAN). We report a case of PAN in a 62-year old HIV1-positive woman. The patient had no co-occurrent hepatitis B virus infection and was negative for antinuclear antibodies. She presented with sicca syndrome, necrotic purpura, myalgias and polyneuropathy. Skin, muscle and nerve biopsies showed signs of necrotizing vasculitis. Multiple microaneurysms typical of PAN were present on branches of the abdominal aorta. The symptoms due to vasculitis regressed after treatment with corticosteroids in bolus injections and plasmapheresis. AZT was not given owing to intolerance. The literature on vasculitis associated with HIV infection is reviewed.
Periarteritis nodosa is a necrotizing vasculitis diagnosed on clinical, angiographic and histological criteria. We conducted a retrospective study of the various clinical and paraclinical manifestations of the disease in a series of 27 patients hospitalized in an Internal Medicine department. Visceral angiography showed microaneurysms in only 12.5% of the cases, and we consider that the indications of this method are limited. Segmental necrotizing vasculitis of the medium- and small-caliber arteries was found in only 33% of muscle biopsies. This criterion has low sensitivity and must be improved by systematic electromyography which showed abnormal results in 87% of the patients. Due to the insufficient sensitivity of paraclinical criteria, the clinical criteria proposed by Godeau and Guillevin are of great practical value. However, we suggest that their definition should be modified on three points: multineuritis should be replaced by peripheral neuropathies; livedo should be included in the cutaneous criterion, and positive serology for hepatitis B or C virus should be added to the positivity criteria.
We report a case of periarteritis nodosa revealed by blindness due to occlusion of the central retinal artery. The disease appeared after a serous otitis and was accompanied by thrombocytosis. Its outcome was favourable under corticosteroid therapy, but it was complicated by aortic valve regurgitation. Lesions of fibrinoid necrosis were found on the aortic cusps removed during surgical replacement. It seems highly probable that the ocular and valvular lesions were specific, although this cannot be directly demonstrated. The case presented here is exceptional, and the relevant literature is reviewed.
The clinical and autopsy findings of a three-month-old male infant with infantile periarteritis nodosa are described adn the literature reviewed. Different stages of the inflammatory vascular process could be seen in the iliacal, axillary, carotidal, coronary and the small periadrenal-tissue-arteries. Secondary changes were found in the axillary and coronary arteries consisting of aneurysmal dilatation and thrombosis. Fatal myocardial infarction occurred thirty-nine days following hospital admission.
A 30 year old man died during coronary artery bypass grafting for presumed premature atherosclerotic coronary disease. Autopsy revealed vasculitis with characteristics of periarteritis nodosa of the coronary arteries with severe luminal narrowing, but without aneurysms. This is the first report of a patient with these findings studied angiographically and at autopsy.
A case is presented of a 43-year-old man who died suddenly and unexpectedly from cardiac malignant arrhythmia. Autopsy revealed isolated coronary arteritis involving primarily the left coronary stem and extending into the proximal half of its anterior descending branch. The most striking feature of the disease was marked fibrous periarteritis. Similar changes were present segmentally in the peripheral third of the right coronary artery, and also as small isolated foci of adventitial fibrosis in the aortic base. With some hesitation, we classify the case as coronary Takayasu's arteritis.