Cristobo BT, Lacoste PMJ, Salellas BJ, González SY

Language: Spanish
References: 17
Page: 490-500
PDF size: 146.12 Kb.

ABSTRACT

Background: polyarteritis nodosa is a vasculitis of medium-sized vessels, characterized by inflammation or necrosis of blood vessels leading to occlusion and therefore to ischemia of tissue supplying.
Case report: 15 years old, white, male patient with history of long febrile pictures without diagnosis, he had multiple admissions in different institutions in the country with the suspicion of histiocytosis or lymphoproliferative disease, various studies involving bone marrow without infiltration and lymph node biopsy were performed, results ruled out these diseases. In one of these episodes and three years later was referred to the Pediatric Rheumatology service in Camagüey province, with history of fever up to 38.5 ° c for 16 days, an ulcer infected with a staphylococcus in the same culture on the right arm. After his examination also was found Raynaud´s phenomenon and livedo reticularis, a diagnostic possibility of vasculitis was suggested.
Conclusions: the antinuclear antibodies carried out were positive and confirmed diagnosis of polyarteritis nodosa, which was made after three years of evolution; currently under treatment of extreme immunosuppression with high doses of steroids and cyclophosphamide with favorable evolution of the general picture, no fever, but remains damage at the level of renal, coronary vessels and distal regions of four extremities established previously.

REFERENCES

1. Sneller MC, Fauci AS. Pathogenesis of vasculitis syndromes. Med Clin North Am. 2003; 81:22141.

2. Mannik M. Serum sickness and Pathophysiology of immune complexes. In: Rich R, editor. Clinical Immunology: Principles and practice. St Louis: Mosby; 2007.p.467523.

3. Carbajal RL, Zarco RJ, Luna FM, Rodríguez HR, Barrios FR, Reynés MJ. Las vasculitis. Frecuencia en un hospital de tercer nivel. Acta Pediatr Mex. 2008; 24(4):24852.

4. Althreya BH. Vasculitis in children. Pediatr Clin North Am. 2009; 42:116788.

5. Emilio B, González MD. Las vasculitis sistémicas. Ann interamericano Med. 2009; 17(12):6325.

6. Carbajal RL, Zarco RJ, Luna FM, Rodríguez HR, Barrios FR, Reynés MJ. Las vasculitis. Frecuencia en un hospital de tercer nivel. Acta Pediatr Mex. 2009; 24(5)26978.

7. Nash MC, Dillon MJ. Antineutrophil cytoplasm antibodies and vasculitis. Arch Dis Child. 2007; 77:2614.

8. Lie JT. Nomenclature and classification of vasculitis: plus ca change, plus c´est la même chose. Arthritis Rheum. 2004; 37:1816.

9. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, et al. Nomenclature of systemic vasculitides. Proposal of an International Conference. Arthritis Rheum. 2009; 37:18792.

10. Cuttica RJ. Vasculitis in children: a diagnostic challenge. Curr Probl Pediatr. 2009; 27:30918.

11. Zarco RJ, Carbajal RL, Reynés MJ, Rodríguez HR, Barrios FR. Poliarteritis nodosa clásica. Acta Pediatr Mex. 2006; 22:834.

12. Gonzáles GM, Garcia PC. Epidemiology of the Vasculitis. Rheum Dis Clin North Am. 2009; 27:122.

13. Langford CA. Treatment of polyarteritis nodosa, microscopic polyangiitis, and ChurgStrauss syndrome: where do we stand?. Arthritis Rheum. 2009; 44(3):50812.

14. Cantillo JJ, Martínez AR, Córdoba R, López R. Vasculitis sistémica y riñón .Poliarteritis nodosa clásica (PAN) y Poliangeitis microscópica (PAM). Acta Méd Colombia. 2009; 28(1):506.

15. Gushi A, Hashiguchi T, Fukumaru K, Usuki K, Kanekura T, Kanzaki T. Three cases of polyarteritis nodosa cutanea and a review of the literature. J Dermatol. 2008; 27(12):77881.

16. Guillevin L, Lhote F. Treatment of polyarteritis nodosa and microscopic polyangiitis. Arthritis Rheum. 2007; 41(12):21005.

17. Guillevin L, Cohen P. Polyarteritis nodosa: clinical, prognostic and therapeutic features. Ann Med Interne (Paris). 2007; 151(3):18492.