Isolated ovarian polyarteritis nodosa

Polyarteritis nodosa is a rare disorder and a form of systemic vasculitis. A 48 year-old female was admitted to the hospital because menorrhagia and pelvic pain in February 1993. The patient underwent exploratory laparotomy resulting in a total hysterectomy and bilateral salpingo-oophorectomy for myoma of uterus and a right adnexal cystic mass. Histopathologic examination revealed left ovarian periarteritis nodosa. Further investigation and 9 months follow-up failed to show any systemic involvement. To our knowledge the isolated ovarian polyarteritis nodosa is the first case in the literature.     

Polyarteritis nodosa and the antiphospholipid syndrome

We describe a case of classical polyarteritis nodosa (PAN) with visceral aneurysms presenting with renal infarction and hypertension. The female patient also had all the laboratory features of the antiphospholipid syndrome (APS) and 2 months into her illness developed a large iliofemoral thrombosis. She responded well to immunosuppressive therapy and anti-coagulation. Repeat arteriogram showed regression of the visceral aneurysms. The link between PAN and APS, and the therapeutic dilemma posed by this association, are discussed.     

Severe preeclampsia superimposed on polyarteritis nodosa

A patient with a history of drug abuse and histologically diagnosed hepatitis B-related polyarteritis nodosa was admitted for severe hypertension. After a cesarean section because of worsening of her clinical status with severe proteinuria and edema, she improved dramatically. No sign of acute polyarteritis nodosa occurred.     

Polyarteritis nodosa masquerading as neuritic leprosy

A case of lost Copper-T lying partly in the rectal lumen and its removal through the rectal route is described. This case emphasises the importance of rectal examination in the case of lost intra-uterine contraceptive device (IUCD) and highlights the possibility of safe retrieval of an IUCD through the rectal route even when it is partly embedded in the rectal wall.     

Polyarteritis nodosa associated with hepatitis C virus

BACKGROUND: To study the seroprevalence of hepatitis C virus in a cohort of six patients with a diagnosis of polyarteritis nodosa (PAN). METHODS: There have been included six patients with a diagnosis of PAN, carrying out a serodiagnosis of hepatitis B virus (VHB) and C (VHC) this last one by means of the following methods: ELISA, RIBA-II and PCR. RESULTS: These cases (50%) showed exclusive positivity to VHC by means of the three ways of diagnosis, two cases showed positivity to VHB (33.3%), one case (16.6%) showed positivity to both virus (VHB and (VHC) and one case didn't show positivity virus. CONCLUSIONS: It is probable a ethipatogenic relation between hepatitis C virus and polyarteritis nodosa, our sample doesn't show any difference from that written in the literature. The positive rheumatoid factors can give false positive for VHC by means of the technique ELISA because of this it is necessary to confirm the positive by means of the techniques RIBA-II and PCR.     

Inferior suprarenal artery aneurysm in polyarteritis nodosa

A 16-year-old boy with the complaints of fever, abdominal pain, arthralgia and hypertension was found to have polyarteritis nodosa. Selective renal angiography disclosed a 5-mm microaneurysm of the right inferior suprarenal artery, which has not been previously reported in polyarteritis nodosa. Aside from the diagnostic view-point, some of the perirenal and retroperitoneal hemorrhages of unknown origin seen in polyarteritis nodosa might be due to the rupture of suprarenal artery aneurysms.     

Relapsing cutaneous polyarteritis nodosa associated with streptococcal infections

BACKGROUND: Polyarteritis nodosa is an aggressive, often fatal form of vasculitis associated with multi-organ involvement. Cutaneous polyarteritis nodosa is purported to be a more benign form of this disorder with involvement limited to the skin. METHODS: The identification of a female patient from childhood to adulthood documenting repeated episodes of cutaneous polyarteritis nodosa following bouts of recurrent streptococcal pharyngitis. RESULTS: Repeated bouts of streptococcal pharyngitis at ages 11, 28, and 33 years were followed by episodes of cutaneous polyarteritis nodosa, documented by histopathologic skin changes and clinical presentation, and confirmed by therapeutic management. CONCLUSIONS: Various infectious and non-infectious conditions have been linked both to the initiation and relapse of this disease. We describe a patient with recurrent episodes of cutaneous polyarteritis nodosa spanning a period of over 20 years with each episode appearing to be linked to a prior streptococcal infection.     

A case of polyneuropathy by microscopic polyarteritis nodosa

Serum concentrations of sex hormone binding-globulin (SHBG) were determined in patients with hyperthyroidism (n = 94; 12 men, 82 women) due to either Graves' disease (n = 59; 11 men, 48 women), autonomous thyroid adenomas (n = 23; 1 man, 22 women), or subacute thyroiditis (n = 12; all women). Elevated serum concentrations of SHBG were initially seen in 57 of 82 patients (69%) with hyperthyroidism due to either Graves's disease or due to autonomous adenoma. Elevated serum SHBG concentration was more frequent in patients with serum total thyroxine (TT4) concentrations greater than 15.0 microg/dL (32/39 [82%]; including 3 patients with autonomous adenoma) compared to those with serum TT4 concentration between 11.0 and 15.0 microg/dL (21/27 [77%]; including 7 patients with autonomous adenoma), or patients with an isolated elevation of serum total triiodothyronine (TT3) concentration (4/16 [25%]; including 2 patients with autonomous adenoma). Serum SHBG concentration normalized when patients became euthyroid. Only 1 of 12 patients in the hyperthyroid phase of subacute thyroiditis had an elevated serum concentration of SHBG. Serum concentrations of thyroid binding globulin (TBG) and transcortin (CBG) were normal in all but 1 patient. In patients with hyperthyroidism as a result of Graves' disease or autonomous adenoma serum SHBG concentrations were elevated with the greatest elevation found in patients with the highest serum T4 concentrations. The normal concentrations of SHBG in the hyperthyroid phase of subacute thyroiditis most likely reflects the shorter duration of exposure to increased thyroid hormone in this condition.     

Polyarteritis nodosa (PN) complicated with unilateral exophthalmos

A 58-year-old woman suddenly developed right exophthalmos. A CT scan of her orbit revealed an increase in volume and density of extraocular muscles and intraorbital soft tissues that resembled exophthalmos in Graves' disease. The exophthalmos gradually improved without treatment. Two months later she developed mononeuritis multiplex in her limbs, and then showed a sudden onset of swelling of her right calf. Sural nerve biopsy was performed and the diagnosis of polyarteritis nodosa (PN) was established from the histological findings. A rare case of PN with exophthalmos is herein reported with a review of the literature.     

Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization

OBJECTIVE: To investigate the role of transcervical tubal catheterization in diagnosis and treatment of proximal tubal obstruction associated with salpingitis isthmica nodosa. DESIGN: Retrospective case study. SETTING: University hospital and outpatient radiology practice. PATIENTS: Fifty-two women with proximal tubal obstruction associated with salpingitis isthmica nodosa. INTERVENTION: Selective salpingography and catheter recanalization using fluoroscopic guidance. MAIN OUTCOME MEASURES: The number of tubes visualized to the fimbria as a percentage of the tubes with proximal tubal obstruction on the initial hysterosalpingogram was determined as a measure of diagnostic efficacy. To evaluate the treatment potential of catheter recanalization, the patients were grouped according to tubal status at the conclusion of the procedure and subsequent pregnancies were evaluated. RESULTS: Forty-seven of 65 tubes (72%) with proximal tubal obstruction were recanalized successfully. Among the 19 women who were able to conceive only via a recanalized salpingitis isthmica nodosa tube, there were 6 live births (32%) and two tubal pregnancies (10%). CONCLUSION: Selective salpingography allows complete tubal diagnosis in almost three fourths of patients with proximal tubal obstruction and salpingitis isthmica nodosa. The radiographic diagnosis of salpingitis isthmica nodosa may be pressure dependent. Intrauterine pregnancies occur via recanalized salpingitis isthmica nodosa tubes, therefore catheter recanalization may be attempted before tubal microsurgery or IVF in patients with proximal tubal obstruction and associated salpingitis isthmica nodosa.     

Polyarteritis nodosa presenting as temporal arteritis in a 9-year-old child

In a household survey in Guinea-Bissau, 319 episodes of diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient. Mothers with no knowledge of ORS did not use it during the observed attack of diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of ORS, good knowledge of ORS, and having ORS sachets at home. Multivariate Cox regression analyses showed that the presence of ORS sachets at home at the onset of diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and address mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.