Polyarteritis nodosa

Systemic vasculitis Wegener s disease, giant cell arteritis, polyarteritis nodosa... 

Intrinsic Vascular damage Hypercalcemia Hepatorenal syndrome Vasculitis Polyarteritis nodosa Hemolytic uremic syndrom thrombotic thrombocytopenic purpura Emboli Atherosclerotic Thrombotic... 

Pelletier, F. et al, Minocycline-induced cutaneous polyarteritis nodosa with antineutrophil cytoplasmic antibodies, Em J. Dermatol., 13, 396, 2003. 

All sulfonamides, including antimicrobial sulfas, diuretics, diazoxide, and the sulfonylurea hypoglycemic agents, have been considered to be partially cross-allergenic. Flowever, evidence for this is not extensive. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, < 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see below), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

PI8. Prince, A. M., and Trepo. C., Role of immune complexes involving SH antigen in pathogenesis of chronic active hepatitis and polyarteritis nodosa. Lancet 1, 1309-1314 (1971). 

Differential diagnoses of peripheral neuropathy were entertained. Laboratory tests revealed that serum parameters for electrolytes and proteins were all within the normal range. Urine porphyrinogen and porphobilinogen levels were normal. Tests were negative for serum rheumatoid factor and antinuclear antibodies, the latter used in detection of connective tissue diseases such as systemic lupus erythematosus and polyarteritis nodosa that could present with features of peripheral neuropathy. Nerve conduction studies of the radial, ulnar, and median nerves revealed delayed conduction. Biopsies of the ulnar and radial nerves showed loss of nerve fibers and sudanophilic (indicating lipid) deposits in the Schwann cells of the neurons. Similarly, the yellowish plaques of the pharynx showed abundant macrophages filled with sudanophilic material. These deposits were not membrane-bound. 

Certain collagen-like diseases are caused by hypersensitivity reactions to drugs. Hydralazine, and particularly procainamide, may produce a clinical picture similar to systemic lupus erythematosus (43). A number of cases of polyarteritis nodosa have developed during treatment with guanethidine and after repeated exposure to the sulfonamides, penicillin, and iodides (44). Nephropathy has been reported following high doses of methicillin and benzylpenicillin (45). 

HA Dewar, MJT Peaston. Three cases resembling polyarteritis nodosa arising during treatment with guanethidine. BMJ 2 609, 1964. 

Figure 25-30 Nonrhegmatogenous retinal detachment in polyarteritis nodosa.

ANCA Specific for Wegener s granulomatosis, polyarteritis nodosa, and related vasculitis-associated diseases... 

Allergic reactions include rash, fever, hepatitis, agranulocytosis, purpura, aplastic anaemia, peripheral neuritis and polyarteritis nodosa. Rarely, severe skin reactions including erythema multiforme bullosa (Stevens-Johnson syndrome) and toxic epidermal necrolysis (LyelTs syndrome) occur. 

Collagen diseases, if severe, e.g. lupus erythematosus (systemic), polyarteritis nodosa, polymyalgia rheumatica and cranial giant cell arteritis (urgent therapy to save sight), dermatomyositis... 

Shafritz, D.A. Variants of hepatitis B virus associated with fulminant liver disease. New Engl. X. Med. 1991 324 1737-1738 Solis Herruzo, J.A., Mnnoz-Yagne, T. Polyarteritis nodosa and hepatitis B virus infection. Rev. Esp. Enferm. Dig. 2003 95 156. 

Scavizzi, M. Hepatitis C virus in patients with polyarteritis nodosa. Prevalence in 38 patients. Clin. Experim. Rheumatol. 1991 9 253—257... 

Barquist, E.S., Goldstein, N., Ziner, M.X Polyarteritis nodosa presenting as a biliary stricture Surgery 1991 109 16-19... 

J.R. Massive intrahepatic hemorrhage as first manifestation of polyarteritis nodosa. Hepato-Gastroenterol. 1997 44 148—152... 

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