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(Circulation. 2003;107:2870.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Polyarteritis Nodosa Inducing Symmetric Peripheral Gangrene

Herbert L. Fred, MD; J. Humberto Serna, MD; Glenn A. McDonald, MD; S. Sohail Ahmed, MD

From the Divisions of General Medicine (H.L.F.), Nephrology (J.H.S., G.A.M.), and Rheumatology (S.S.A.), The University of Texas Health Science Center at Houston, Tex.

Correspondence to Dr Herbert L. Fred, Internal Medicine, The University of Texas Health Science Center at Houston, 8181 Fannin, Suite 316, Houston, TX 77054.

An extract of the first 100% of the full text is provided, because this article has no abstract.

A47-year-old man with a 1-month history of generalized arthralgias experienced the abrupt onset of fever, myalgias, abdominal pain, and diarrhea. Twenty-four hours later, his fingers and toes appeared cyanotic and then rapidly became necrotic (Figure 1). Aside from an oral temperature of 102°F, his physical examination was otherwise unremarkable.

View larger version (121K): [in this window] [in a new window]   Figure 1. Ischemic necrosis of all fingers and toes.

Pertinent laboratory data included 3+ proteinuria, a serum creatinine value of 4.3 mg/dL, sterile blood and urine cultures, and a negative hepatitis panel. A host of other serological and hematologic studies gave negative or normal results. The chest radiograph disclosed cardiomegaly. Percutaneous renal biopsy showed necrotic parenchyma. Renal angiography demonstrated bilateral arterial microaneurysms (Figure 2).

View larger version (137K): [in this window] [in a new window]   Figure 2. Renal angiogram showing arterial microaneurysms (arrows).

With a presumptive diagnosis of polyarteritis nodosa, the patient received prednisone and cyclophosphamide. His condition stabilized, and he underwent amputation of the necrotic digits. However, 4 months after onset of his symptoms, he suffered a cerebellar hemorrhage and died. At autopsy, the significant finding was polyarteritis nodosa affecting multiple organs.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.