PDF(Pubmed)
Abstract：
UNASSIGNED: This pediatric case report underscores the importance of maintaining a high clinical suspicion for polyarteritis nodosa (PAN) in patients presenting with atypical features, such as migratory arthritis and subcutaneous nodules. Importantly, it highlights the focus on the potential relationship between streptococcal infection and cutaneous PAN. Early recognition and prompt, aggressive treatment is critical, as PAN can be a life-threatening condition if left unmanaged. This case emphasizes the need for a multidisciplinary approach to effectively identify and manage this rare vasculitis disorder in the pediatric population.
UNASSIGNED: Polyarteritis nodosa (PAN) is a rare and life-threatening vasculitis with diverse clinical presentations, posing a diagnostic challenge. Early recognition and prompt intervention are crucial to prevent organ damage. We present the case of an 8-year-old boy who exhibited atypical symptoms including migratory arthritis, myalgia, digital discoloration and ischemic changes, and subcutaneous nodules. Initial concerns for septic arthritis were ruled out. A comprehensive evaluation revealed elevated inflammatory markers and a confirmatory skin biopsy demonstrating active leukocytoclastic vasculitis, are highly suggestive of a diagnosis of PAN. Notably, elevated ASO titers suggested a possible concurrent streptococcal infection. The aggressive treatment approach with high-dose aspirin, steroids, methotrexate, and tocilizumab is justified given the severity of the patient\'s symptoms and the nature of the disease process. This case underscores the importance of considering PAN in the differential diagnosis for children presenting with atypical features. Early diagnosis and prompt intervention, including addressing potential infectious triggers, are crucial for optimal outcomes in pediatric PAN.
UNASSIGNED: Polyarteritis nodosa (PAN) is a rare and life-threatening vasculitis with diverse clinical presentations, posing a diagnostic challenge. Early recognition and prompt intervention are crucial to prevent organ damage. We present the case of an 8-year-old boy who exhibited atypical symptoms including migratory arthritis, myalgia, digital discoloration and ischemic changes, and subcutaneous nodules. Initial concerns for septic arthritis were ruled out. A comprehensive evaluation revealed elevated inflammatory markers and a confirmatory skin biopsy demonstrating active leukocytoclastic vasculitis, are highly suggestive of a diagnosis of PAN. Notably, elevated ASO titers suggested a possible concurrent streptococcal infection. The aggressive treatment approach with high-dose aspirin, steroids, methotrexate, and tocilizumab is justified given the severity of the patient\'s symptoms and the nature of the disease process. This case underscores the importance of considering PAN in the differential diagnosis for children presenting with atypical features. Early diagnosis and prompt intervention, including addressing potential infectious triggers, are crucial for optimal outcomes in pediatric PAN.
摘要：
■这份儿科病例报告强调了在表现为非典型特征的患者中，临床高度怀疑结节性多动脉炎（PAN）的重要性。如偏头痛和皮下结节。重要的是,它强调了对链球菌感染与皮肤PAN之间潜在关系的关注。早期识别和迅速，积极治疗至关重要，因为如果不进行管理，PAN可能会危及生命。此病例强调需要采用多学科方法来有效识别和管理儿科人群中这种罕见的血管炎疾病。
结节性多动脉炎（PAN）是一种罕见且危及生命的血管炎，临床表现多样，构成诊断挑战。早期识别和及时干预对于防止器官损伤至关重要。我们介绍了一个8岁男孩的病例，他表现出包括偏头痛在内的非典型症状，肌痛，数字变色和缺血变化，和皮下结节。排除了对化脓性关节炎的最初担忧。综合评估显示炎症标志物升高，皮肤活检证实为活动性白细胞碎裂性血管炎，高度提示PAN的诊断。值得注意的是,ASO滴度升高提示可能并发链球菌感染.大剂量阿司匹林的积极治疗方法，类固醇,甲氨蝶呤,鉴于患者症状的严重程度和疾病过程的性质，托珠单抗是合理的。此病例强调了在表现出非典型特征的儿童的鉴别诊断中考虑PAN的重要性。早期诊断和及时干预，包括解决潜在的传染性触发因素，对于儿科PAN的最佳结果至关重要。
结节性多动脉炎（PAN）是一种罕见且危及生命的血管炎，临床表现多样，构成诊断挑战。早期识别和及时干预对于防止器官损伤至关重要。我们介绍了一个8岁男孩的病例，他表现出包括偏头痛在内的非典型症状，肌痛，数字变色和缺血变化，和皮下结节。排除了对化脓性关节炎的最初担忧。综合评估显示炎症标志物升高，皮肤活检证实为活动性白细胞碎裂性血管炎，高度提示PAN的诊断。值得注意的是,ASO滴度升高提示可能并发链球菌感染.大剂量阿司匹林的积极治疗方法，类固醇,甲氨蝶呤,鉴于患者症状的严重程度和疾病过程的性质，托珠单抗是合理的。此病例强调了在表现出非典型特征的儿童的鉴别诊断中考虑PAN的重要性。早期诊断和及时干预，包括解决潜在的传染性触发因素，对于儿科PAN的最佳结果至关重要。
