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   Introduction
   Case Report
   Discussion
   References
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CASE REPORT
Year : 1999  |  Volume : 65  |  Issue : 6  |  Page : 292-293

Cutaneous polyarteritis nodasa




Correspondence Address:
R R Mittal


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Source of Support: None, Conflict of Interest: None


PMID: 20921692

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How to cite this article:
Mittal R R, Walia R, Bansal N, Puneet. Cutaneous polyarteritis nodasa. Indian J Dermatol Venereol Leprol 1999;65:292-3

How to cite this URL:
Mittal R R, Walia R, Bansal N, Puneet. Cutaneous polyarteritis nodasa. Indian J Dermatol Venereol Leprol [serial online] 1999 [cited 2019 Aug 25];65:292-3. Available from: http://www.ijdvl.com/text.asp?1999/65/6/292/4845





  Introduction Top


Cutaneous polyarteritis nodosa (CPN) is a benign, recurring chronic distinct entity characterised by symptomless/painful crops of 2-3 cm size cutaneous nodules around bluish sharply marginated big ulcers on feet, legs, forearms, trunk and shoulders. It may be accompanied by livedo reticularis, fever, myalgia, arthralgia and neuropathy.[1-3] There is no visceral involvement unlike periarteritis nodosa, hence has a good prognosis.[4] The disease responds to dapsone. First case of CPN was reported by us in Indian literature in 1987.[5]


  Case Report Top


A - 50-year-old man was admitted with ulcers on the right forearm [Figure - 1] and buttock since one month. The ulcers on right forearm were 3 in number, 1x0.75 cm and 1.5x4.5 cm in size with well-defined bluish margins, hyperaemic floor studded with yellowish granulation tissue and serous discharge. Periphery of ulcers revealed multiple skin coloured, smooth surfaced, slightly painful, tender, 1-4 cm in size papulonodular lesions which were attached to underlying structures. Right forearm could not be extended fully. There was restriction of movements at right elbow joint. Buttock lesion was similiar to forearm lesions. In addition there were skin-coloured slightly painful, tender mobile nodules 1.5x2 cm one each on the left shoulder and right thigh. The nodules did not break. There was off and on fever, myalgia and neuropathy over upper and lower limbs with discrete, well-defined areas of hypoaesthesia. Patient was put on dapsone 50mg tid. Patients improved and in three weeks time the ulcers were reduced to one-third in size.

Routine investigations were normal. ESR was 24 mm 1st hour. X-ray of elbow showed periosteal thickening and new bone formation. Histopathology showed prominent vasculitis as thickened blood vessels due to fibrinoid deposits, with proliferation of endothelial cells and perivascular infiltrate consisting of neutrophils with admixture of lymphocytes, plasma cells and macrophages. At places the vessel wall was infiltrated with neutrophils. The dermal collagen looked eosinophilic and swollen with evident areas of necrosis and extravasation of RBCs.


  Discussion Top


The present case was clinically diagnosed as a case of CPN as he had multiple, tender sharp ulcers with well defined bluish margins surrounded by skin-coloured variable sized, papulo-nodular lesions, mononeuritis multiplex, fever and myalgia. Patient was being treated with systemic steroids and antibiotics before admission without any beneficial effect. We also continued the same treatment till histopathology report and noticed only marginal improvement with the above therapy. Patient responded dramatically to dapsone 50mg thrice daily.



 
  References Top

1.Kint A, Van Herpe L. Cutaneous periarteritis nodosa. Dermatologica 1979;158:185-189.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Diaz-Perez JL, Winkelmann RK. Cutaneous periarteritis nodosa. Arch Dermatol 1980;110:407-414.  Back to cited text no. 2    
3.Borrie P. Cutaneous polyarteritis nodosa. Br J Dermatol 1972;87:87-95.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Gospen JB, Graham W, Lazarus GS. Cutaneous polyarteritis nodosa. Arch Dermatol 1983;119:326-329.  Back to cited text no. 4    
5.Mittal RR, Gill SS. Cutaneous polyarteritis nodosa. Indian J Dermatol Venereol Leprol 1987;53:37-38.  Back to cited text no. 5    


    Figures

[Figure - 1]



 

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