Perirenal hematoma and involvement of the temporal artery in a patient with polyarteritis nodosa (PAN) / Hematoma perirrenal e envolvimento da artéria temporal em paciente com poliarterite nodosa (PAN)

Descrevemos o caso de um paciente masculino, 48 anos, com poliartralgias e mialgias migratórias, associadas a febre e emagrecimento com dois meses de evolução; um episódio de dor testicular bilateral; e cefaleia unilateral pulsátil com espessamento de artéria temporal esquerda sugerindo arterite temporal. Na evolução, o paciente apresentou hematoma perirrenal esquerdo espontâneo, infartos esplênicos e insuficiência renal aguda oligúrica. Foi tratado com prednisona e ciclofosfamida. Foram realizadas biópsias de artéria temporal esquerda e músculo quadríceps. Os achados clínicos, laboratoriais, radiológicos e intercorrências levaram ao diagnóstico de poliarterite nodosa (PAN).

We report the case of a 48-year-old male with a 2-month history of migratory polyarthralgia, and myalgia associated with fever and weight loss; one episode of bilateral testicular pain; and unilateral pulsatile headache with thickening of the left temporal artery suggestive of temporal arteritis. The patient evolved with spontaneous left perirenal hematoma, splenic infarcts, and oliguric acute renal failure. Treatment included prednisone and cyclophosphamide. The left temporal artery and the quadriceps muscle were biopsied. Clinical, laboratorial, and radiological findings, as well as the intercurrences, led to the diagnosis of polyarteritis nodosa.

Electrophysiologic Characteristics in Systemic Necrotizing Vasculitis Patients with Peripheral Neuropathy

OBJECTIVE: To evaluate the clinical findings and the results of an electrophysiological study in seven patients with a systemic necrotizing vasculitis and neuropathy. METHOD: Clinical and electrophysiological studies were performed in seven patients of whom three had a polyarteritis nodosa, other three a Churg-Strauss syndrome, and one an overlapping syndrome. RESULTS: In the electrophysiological study, five patients presented an overlapping multiple mononeuropathy, one a multiple mononeuropathy and the other one a distal symmetric polyneuropathy. The neuropathies were mainly axonopathies with a decreased amplitude of compound motor action potential and sensory nerve action potential; however one patient showed the conduction blocks in the tested nerves. In electromyography, the most prominent feature was a neurogenic pattern with fibrillation potentials and reduced recruitments. No patient had a myopathic pattern. CONCLUSION: The most prominent features of the systemic necrotizing vasculitis patients with neuropathy were the axonopathic findings in the nerve conduction studies and neurogenic pattern in the electromyographic studies. Electrodiagnostic study was helpful for the diagnosis of vasculitic neuropathy, however further studies would be necessary to clarify the characteristics of the neuropathy of polyarteritis nodosa and the Churg-Strauss syndrome.