Cutaneous Polyarteritis Nodosa LARRY W. MORELAND, M.D., GENE V. BALL, M.D., Birmingham, Alabama
utaneous polyarteritis nodosa (CPN) has been differentiated from the systemic form of the disC ease by its benign course and by the absence of visceral lesions; however, the syndrome may encompass extracutaneous features such as arthralgias, arthritis, neuropathy, and myopathy. Diagnosis is suggested by an excisional biopsy of the affected skin lesions in which necrotizing arteritis of the subcutaneous or lower dermis is found, and by the absence of visceral lesions. The purpose of this article is to report six additional cases of CPN and to review the pertinent literature.
CASE REPORTS We have identified six patients at the University of Alabama at Birmingham (UAB) in whom this diagnosis has been made based on criteria described by Borrie [l] and Diaz-Perez and Winkelmann . The clinical characteristics of these patients are summarized in Table I. The average age at onset of symptoms was 33 years, with a range of 15 to 72 years. The mean length of follow-up has been 10.4 years (range: 2 to 19 years). No patient has died, and none has developed clinical evidence of systemic vasculitis. Treatment has consisted of both low and high doses of prednisone as well as various nonsteroidal anti-inflammatory agents (NSAIDs). Patient 1 This 36-year-old man was first seen in January 1980 with a complaint of tender, red nodules on the right foot and ankle for nearly 10 years and burning pain in the right foot that occasionally radiated to the knee. The lesions and pain were episodic, lasting many months, disappearing for a few months, and then returning. Pain intensified with activity and decreased with elevation of the leg, warm soaks, and various NSAIDs. Three years before evaluation at UAB, there was simultaneous onset of inflammatory foot nodules and superficial phlebitis. The vein was excised, the nodules disappeared, and he remained well until 9 months before hospitalization, when painful lesions appeared. A short course of a NSAID was ineffective; however, oral prednisone resulted in diminution but not disappearance of the nodules. Remarkable physical findings were confined to the skin. There were six 2-cm, tender, non-pulsatile red nodules on the right foot; the skin overlying the dorsalis pedis artery was red, and the artery appeared to be thrombosed. The results of the neurologic examination were normal.
From the Dwion of Clintcal Immunology and Rheumatology, The Universitv of Alabama at Blrmwham. Bnminaham. Alabama. Reauests for reormts