TY - JOUR
T1 - Diplopia and myalgia
T2 - Potential heralding symptoms of polyarteritis nodosa
AU - Miteva, Maria
AU - Norgauer, Johannes
AU - Ziemer, Mirjana
N1 - Funding Information:
I wish to thank Andreas Pluckthun and Alice A. Jarvis for aid in the preparation of the figures, Raymond A. Deems for critical reading of the manuscript, and Judith A. St. Austin for efficient word processing of the manuscript. I thank Professor Jan Drenth for supplying the X-ray crystal coordinates of the bovine pancreatic enzyme and my graduate students Paul L. Darke, Andreas Pluckthun, and Theodore L. Hazlett for inputting them to the graphics systems. Our work on the phospholipases was supported by NIH Grant GM 20,501 and NSF Grant PCM 82-16963.
PY - 2007
Y1 - 2007
N2 - Protean clinical manifestations of polyarteritis nodosa are described. Hence, a sequential multidisciplinary diagnostic approach, including thorough dermatologic examination and histologic verification in particular, are warranted in patients suspected of having this condition. The lack of both pathognomonic visceral and/or cutaneous features and specific serologic tests for identifying polyarteritis nodosa explains why making the diagnosis is often delayed. Furthermore, in some patients making the diagnosis is hampered because symptoms are missing or only mildly expressed. We report on a 67-year-old man diagnosed with systemic polyarteritis nodosa whose primary complaints included diplopia, extraordinary muscular pain of the lower extremities, and impaired walking. Inconspicuous subcutaneous nodules developed subsequently. The patient was treated initially with a pulse therapy of prednisolone (1000 mg/day for 2 days), followed by prednisolone 100 mg/day, gradually reducing over weeks. Rapid improvement in clinical and laboratory status was noted. The key message from this case report is that symptoms such as severe muscular pain of the lower extremities and acute diplopia, although also common to other systemic vasculitides and systemic autoimmune diseases, should raise early suspicion of a developing polyarteritis nodosa.
AB - Protean clinical manifestations of polyarteritis nodosa are described. Hence, a sequential multidisciplinary diagnostic approach, including thorough dermatologic examination and histologic verification in particular, are warranted in patients suspected of having this condition. The lack of both pathognomonic visceral and/or cutaneous features and specific serologic tests for identifying polyarteritis nodosa explains why making the diagnosis is often delayed. Furthermore, in some patients making the diagnosis is hampered because symptoms are missing or only mildly expressed. We report on a 67-year-old man diagnosed with systemic polyarteritis nodosa whose primary complaints included diplopia, extraordinary muscular pain of the lower extremities, and impaired walking. Inconspicuous subcutaneous nodules developed subsequently. The patient was treated initially with a pulse therapy of prednisolone (1000 mg/day for 2 days), followed by prednisolone 100 mg/day, gradually reducing over weeks. Rapid improvement in clinical and laboratory status was noted. The key message from this case report is that symptoms such as severe muscular pain of the lower extremities and acute diplopia, although also common to other systemic vasculitides and systemic autoimmune diseases, should raise early suspicion of a developing polyarteritis nodosa.
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U2 - 10.2165/00128071-200708030-00004
DO - 10.2165/00128071-200708030-00004
M3 - Article
C2 - 17492845
AN - SCOPUS:34347273752
VL - 8
SP - 175
EP - 178
JO - American Journal of Clinical Dermatology
JF - American Journal of Clinical Dermatology
SN - 1175-0561
IS - 3
ER -