Surgery>>>>>Arterial Disease
Question 38#

The following is true regarding polyarteritis nodosa (PAN) EXCEPT:

A. Is predominantly treated with steroid and cytotoxic agent therapy
B. Predominantly affects women over men by a 2:1 ratio
C. Presenting symptoms include low-grade fever, malaise, and myalgia
D. May be sufficiently diagnosed by skin biopsy

Correct Answer is B

Comment:

Polyarteritis nodosa (PAN) is another systemic inflammatory disease process, which is characterized by a necrotizing inflammation of medium-sized or small arteries that spares the smallest blood vessels (ie, arterioles and capillaries). This disease predominantly affects men over women by a 2:1 ratio. PAN develops subacutely, with constitutional symptoms that last for weeks to months. Intermittent, low-grade fevers, malaise, weight loss, and myalgias are common presenting symptoms. As medium-sized vessels lie within the deep dermis, cutaneous manifestations occur in the form of livedo reticularis, nodules, ulcerations, and digital ischemia. Skin biopsies of these lesions may be sufficient for diagnosis. Inflammation may be seen histologically, with pleomorphic cellular infiltrates and segmental transmural necrosis leading to aneurysm formation. Neuritis from nerve infarction occurs in 60% of patients, and gastrointestinal complications occur in up to 50%. Additionally, renal involvement is found in 40% and manifests as microaneurysms within the kidney or segmental infarctions. Cardiac disease is a rare finding except at autopsy, where thickened, diseased coronary arteries may be seen, as well as patchy myocardial necrosis. Patients may succumb to renal failure, intestinal hemorrhage, or perforation. End-organ ischemia from vascular occlusion or aneurysm rupture can be disastrous complications with high mortality rates. The mainstay of treatment is steroid and cytotoxic agent therapy. Up to 50% of patients with active PAN will experience remission with high dosing.